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Central Venous Access And Picc Line Services In Mukundapur, Kolkata - Manipal Hospitals

Central Venous Access and PICC Line Services

Central Venous Access And PICC Line Services in Mukundapur, Kolkata

A central venous catheter (CVC) is an elongated tube inserted into a major vein in the groin, chest, or neck to access circulation. It is longer and penetrates deeper into larger blood arteries compared to a standard IV, allowing for longer-term placement. There are two types of CVCs: non-tunnelled, typically temporary catheters placed in major veins near the neck, chest, or groin, and tunnelled catheters, which are placed subcutaneously for extended use.

A peripherally inserted central catheter (PICC) is inserted into the upper arm instead of the neck, chest, or groin. It consists of a long, flexible tube inserted into a superficial arm vein and advanced to the largest vein near the heart. PICCs are often inserted in outpatient settings and monitored by ultrasound for precise placement. With numbing of the insertion site and secure fastening with sterile dressing, patients typically experience minimal discomfort during PICC insertion. The PICC is used as a temporary line before inserting a permanent device.
 

FAQ's

CVC typically stands for Central Venous Catheter. Indications for inserting a central venous catheter include:

  • A CVC is convenient for long-term treatments like infection or cancer therapy, providing easy blood access for medical procedures.

  • In urgent cases or while waiting for an AV fistula to mature, a CVC may be used temporarily for haemodialysis.

  • AV fistulas require several months to mature, but a CVC can be used immediately after placement.

  • If AV fistula creation is not possible due to issues like small or scarred veins, a CVC may serve as the primary dialysis access.

Central venous catheters (CVCs) offer several advantages in clinical practice:

  • Immediate access: Suitable for urgent or emergent dialysis needs as it can be utilised right after placement.

  • Long-term access: This can remain in place for extended periods, ranging from days to months, making it ideal for patients undergoing prolonged treatment.

  • Helps provide parenteral nutrition for critically ill paediatric patients.

  • Needle-free: Eliminates the need for needles during access, whether for medication administration or dialysis. Tubes from the catheter connect directly to the IV tubing or the dialysis machine, and blood can be drawn from the CVC for routine blood tests, avoiding the use of needles.

While central venous catheters (CVCs) have numerous benefits, they also come with potential disadvantages and risks.

Risk of severe infection: Compared to other dialysis access techniques, CVCs carry a greater risk of systemic or localised infections, which might result in hospitalisation. The elevated rates of morbidity and death associated with catheter-related bloodstream infections (CRBSI) make them a cause for particular concern.
Risk of clotting increases: Blood clots might develop inside or on the catheter, preventing blood flow. These clots usually require pharmacological intervention to dissolve, which might interfere with the course of treatment.
Vascular damage: Using a CVC for an extended period can cause vascular wall damage and vein constriction, or stenosis, which can complicate future access and reduce blood flow.
 

A PICC line is used for the direct delivery of medications and treatments into the major central veins near the heart. It's typically recommended when frequent needle sticks are necessary for medication administration or blood draws, offering a more convenient and less invasive option. Typically intended as a temporary solution, a PICC line is suitable for treatments lasting several weeks. Common uses include cancer therapies, such as chemotherapy and targeted therapy drugs; liquid nutrition delivery for children with digestive system issues; and the administration of antibiotics or antifungal medications for serious infections. Additionally, medications that may irritate small veins are safely administered through a PICC line, as the larger chest veins dilute the medications more rapidly, reducing the risk of vein injury.
 

Your child’s doctor may order blood tests to check platelet levels and imaging tests like X-rays or ultrasounds to visualise veins. Discuss any health conditions, past surgeries, arm injuries, burns, or radiation treatment that your child has undergone with your doctor. Also, disclose any history of kidney disease in your child, as PICC lines may not be suitable if dialysis is needed in the future. Adjustments, like platelet-boosting medications, may be made to minimise risks during the procedure. Explain the procedure to the child with age-appropriate language and reassure them.
 

PICC line complications may include bleeding, nerve injury, irregular heartbeat, vein damage, blood clots, infection, and blockage or breakage of the PICC line. Treatments are available for some complications to retain the PICC line, while others may necessitate its removal. Depending on the severity, alternative options like placing another PICC line or utilising a different type of central venous catheter may be recommended by your doctor.
 

A sterile environment must be established, informed consent must be obtained, and the child must be assessed before a Central Venous Catheter (CVC) is inserted. The femoral, subclavian, and internal jugular veins are common insertion sites. Using ultrasound-guided venipuncture, cleaning the area, and patient placement are all steps in the procedure. A guidewire is advanced, and then the catheter and dilator are positioned. The catheter is fastened, and imaging confirms its location. Every location has unique benefits and hazards, and to reduce problems, aseptic procedures and appropriate techniques are crucial.
 

There are various cautious processes involved in removing a PICC line. Assess the patient first, then get informed consent from their guardian or parents. Get materials ready, such as an antiseptic solution and sterile gloves. Clear the area and take out any sutures used for security. When the patient is exhaling, carefully and steadily remove the catheter. Check the integrity of the catheter tip. After controlling the bleeding with pressure, cover the area with a sterile dressing. Keep an eye out for any difficulties, record the process, appropriately dispose of any leftover items, and provide the child’s parent aftercare instructions.
 

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