Vascular perforation by central venous catheter

Vascular perforation by central venous catheter It occurs when the tip of the catheter is displaced. It can occur at any level and regardless of where the other end is located.

Vascular perforation It is an infrequent complication. Only 10% of the perforations take place in central veins, the correct diagnosis is usually made late, contributing to a high risk of mortality in these patients.

Ultrasound is used to evaluate and identify a suitable vein for catheter placement. It also allows the interventional radiologist to identify the appropriate veins.

Types of vascular access catheters

Unlike the catheter used in a standard intravenous line, a vascular access catheter is more durable, and it does not get clogged or easily infected.

These catheters are designed so that they extend into the larger central vein close to the heart. Catheters vary in size, length and number of channels, depending on the use for which they are designed. Here are the main types of vascular access catheters:

Peripheral insert central catheter

It is a long catheter that extends from a vein in the arm or leg, even inside the largest vein near the heart. These catheters are called midline catheters when placed in such a way that the tip of the catheter remains in a relatively large vein. However, it does not extend into the larger central vein.

Read also: Access to permanent central venous lines

Central catheter not tunneled

The non-tunneled central catheter may have a larger caliber and It is designed to be placed in a relatively large vein. In addition, this vein is more central, such as the jugular vein in the neck or the femoral vein in the groin.

Tunneled catheter

It may have a cuff that stimulates the growth of tissue that helps keep it in place in the body. There are different sizes and types of tunneled catheters. The tunneled catheter is characteristic of its safety and easy access.

Catheter port

It's about a permanent device which consists of a catheter coupled to a small reservoir.

Risk of vascular perforation

The placement of a central peripheral insertion catheter can be associated with serious complications. Among them is vascular perforation, therefore, the correct position of a central catheter must always be checked.

The diagnostic test of choice of vascular perforation at the central level is the computerized tomography with contrast. There are two types of risks associated with vascular access catheters; those that occur during the performance and those that occur because the device is in the body. Some of these risks are:

• Infection at the site of the incision shortly after placing the catheter.
• Risk of hemorrhage.
• Pneumothorax: It is an accumulation of air in the chest that can cause the collapse of one of the lungs. This can occur during catheter placement through a vein in the chest or neck, but it does not occur if a vein in the arm is used.
• On rare occasions the catheter enters an artery instead of a vein. If this happens, the catheter should be removed. Most of the time the artery then heals itself, but occasionally requires a surgical repair.

You may also be interested: Central venous catheters: concept and precautions

Late infection associated with a vascular access catheter

When a vascular access catheter is used, two types of late infection can occur: infection of the skin at the site of catheter insertion or infection in the bloodstream.

When the catheter is not well attached to the skin there is a risk that it may slip accidentally. If this happens, pressure should be applied to the site of the incision with a sterile dressing and the doctor should be notified as soon as possible.

Further, Any type of vascular access catheter can become clogged with a blood clot. The clot can be treated with a medication that dilutes the blood, but sometimes the catheter will have to be removed.

On the other hand, on rare occasions, Patients experience an irregular heartbeat sensation. This sensation may be related to the catheter.