Central venous catheter management: how to prevent complications

Central venous catheters (CVCs) are essential devices for providing dependable access in monitoring and management of both acutely and chronically ill patients. Increasingly, CVCs are the only available access options for renal patients due to the loss of viable peripheral access sites. Protocols for CVC change under sterile technique specific to our institution will be reviewed. The principle routes by which microorganisms (MO) are believed to reach the catheter will be explored along with the most effective strategies in decreasing skin surface colonization. The three most common types of CVC dressings will be reviewed together with documented advantages and disadvantages of each. Thrombus obstructions can complicate CVC use. The literature outlines the prophylactic use of aspirin and warfarin in decreasing the incidence of thrombus formation. Various techniques for anticoagulating catheter lumens after dialysis and indications for these methods will be reviewed. Methods for effective thrombolysis will be discussed along with essential precautions to prevent potentially serious complications. Emphasis will be placed on reviewing the basic methods of site management and preventing the transmission of MOs, including the importance of patient education. Areas requiring further study will also be identified.