Central venous catheter-related complications

CVC-related complications

Insertion-related complications

Precautions for insertion and manipulation:

Precautions for insertion and manipulation:

Insertion-related complications

Laceration of veins / arteries

Laceration of veins and/or arteries

Insertion-related complications

Laceration of veins / arteries

Lacerations of the pleura

Insertion-related complications

Nerve injuries

Nerve injuries

Insertion-related complications

Thoracic duct injuries

Thoracic duct injuries

Insertion-related complications Haematomas

Haematomas at the subcutaneous tunnel or cannulation site

Insertion-related complications

Malposition

Malposition of the tip and displacement

Insertion-related complications

Malposition

Malposition of the CVC

Insertion-related complications

Infections

Infections

Short to medium-term complications:

Local complications

Systemic complications

Infections: catheter-related sepsis, endocarditis, metastatic infections

Thromboses

Pulmonary air embolism

Intolerance reactions to the implanted device; rejection

Heparin-induced thrombocytopenia

Mechanical complications

Malposition, spontaneous retraction or migration of the CVC tip, and accidental removal of the CVC

Disconnection or fragmentation of the CVC with possible embolism

CVC breakage and leakage of fluids

CVC occlusion

Bleeding

Pleural perforation: hemo-, hydro- and pneumothorax

Phlebitis

Infiltration / Extravasation

Infiltration / Extravasation

Deviation/migration, spontaneous retraction or slipping out of the CVC

Deviation/migration, spontaneous retraction or slipping out of the CVC

Fluid leaking from the exit point

Catheter occlusion

Catheter occlusion

Catheter breakage

Catheter breakage

Catheter breakage

Catheter breakage

BLOOD REFLUX IN THE CATHETER

DIFFICULTIES IN DRAWING

DIFFICULTIES IN DRAWING

DIFFICULTIES IN DRAWING

PRECIPITATION OF SUBSTANCES FOR PARENTERAL NUTRITION OR DRUGS

For TPN (Total Parenteral Nutrition) containing lipids:

Air embolism

Heparin-induced thrombocytopenia

INFECTIONS

Infection of the CVC insertion and exit site

Regular dressing every 7 days

More frequent dressing and skin swab

Treatment in case of positive swab

Skin swab

more frequent dressing antibiotic therapy

If the infection persists, remove the CVC

Infections of the exit site

The catheter exit site infection occurs along the path from the skin surrounding the exit point of the catheter to the fixation cuff (or within 2 cm from the exit site)

Naturally, this kind of infection can occur only in patients with partially implantable devices

Infection of the subcutaneous tunnel

This kind of infection can occur both in partially and totally implantable catheters

In partially implantable catheters, the infection of the subcutaneous tunnel is located along the subcutaneous path from the catheter fixation cuff (or beyond 2 cm from the exit site) to the insertion of the catheter into the vein

In totally implantable catheters, for obvious reasons of proximity, the tunnel infection is associated with an infection of the subcutaneous pocket

Treatment

Should the CVC be kept or removed?

In the case of a Port infection, it is almost absolutely necessary to remove the catheter. As to external catheters, the removal depends on the aetiology of the infection (in general, Gram-positive infections can be treated without removing the catheter, while Gram-negative ones and Candida infections usually require removal), and on the clinical picture.

Antibiotic therapy, possibly targeted to the causal agent, for 10-15 days, is indicated. If the catheter is preserved, the antibiotic therapy must be infused into the catheter itself.

CVC-related sepsis is defined by the occurrence of one of the following conditions:

a) presence of a bacterial colony count that is ten times higher in the culture of blood drawn from the catheter as compared to the blood drawn from a peripheral vein

b) identification of the same pathogen (the identicality should theoretically be confirmed by genetic testing) both in the blood culture and on the tip of the catheter that was removed

c) identification of the same microorganism in the blood culture and in the culture of the pus sample taken at the catheter exit site, along the subcutaneous path, or from the catheter pocket

d) identification of a microorganism in the culture of a sample taken from the catheter tip

e) fever (>38° C) associated with shivers and tremor within 30-120’ of manipulation of the catheter, and, if available, positive blood culture of a sample taken at the fever onset

The correlation between sepsis and CVC can be supposed (by clinical examination) or ascertained (by microbiological tests)

Treatment of the CVCrelated infection

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