If you need to start hemodialysis before having a permanent access created, chances are you might need to have a central venous catheter (CVC) placed, at temporarily, until you can receive another more permanent dialysis access. What exactly does this mean? And are there any central venous catheter complications you should be aware of?
Because they have fewer complications, an AV Fistula or an AV Graft are the preferred types of access if you are going to require hemodialysis. However, both the AV Fistula and AV Graft are created surgically, and thus need time to heal before they can be used for dialysis.
If you’re unable to immediately get a fistula or graft, or if your fistula or graft are not ready to use, there may be a need for a temporary access. In this case, a nephrologist, interventional radiologist or vascular surgeon may have to place a CVC.
Exactly What is a CVC?
Occasionally, for people who need to start hemodialysis immediately, a CVC might have to be placed. A CVC is a long, y-shaped, hollow plastic tube that is threaded though one of the central veins found in your neck, chest or groin.
Getting a CVC
While CVCs are not the best access option and are generally avoided when possible, patients who need to begin hemodialysis immediately and do not have an AV Fistula or an AV Graft will need a catheter – even if it’s only temporarily.
In fact, more than 5 million CVCs are placed every year in the United States. i It’s important to understand that major complications can occur with CVCs, including:
- Damage to central veins
- Pulmonary, or lung, complications
- Cardiac, or heart, complications
- Device dysfunction
The 5 Most Common Central Venous Catheter Complications
1. Damage to Central Veins
Damage to central veins, including injury, bleeding and hematoma (a swelling that consists of clotted blood), can occur during CVC placement. Studies shows that puncture of a vein occurs in 4.2–9.3% of catheter placements. ii,iii Injury to the vein occurs more often when the catheter is inserted into the femoral, or leg vein, and less often when it’s placed in the internal jugular vein. iv
Damage to central veins and stenosis of the central veins may limit future access sites.
2. Pulmonary Complications
During the CVC insertion procedure, a number of lung-related complications can occur, including:
- Fluid can build-up of between the lining of your lungs and your chest cavity.
- Injury can occur to your windpipe, or trachea.
- Injury can occur to the laryngeal nerve, which controls your voice box.
- Air embolism, or a blockage of blood supply caused by air bubbles, can occur. iv
3. Cardiac Complications
Cardiac complications such as abnormal heart rhythms or, although rare, a complete shutdown of the heart, called cardiac arrest, may occur during placement of a CVC.
4. Device Dysfunction
A number of complications can occur that are directly related to the device, or catheter, but these generally take anywhere from weeks to months to recognize. Potential complications from device dysfunction include:
- Cracking or breaking of the catheter itself.
- Thrombosis, or a blood clot.
- Obstruction of the catheter.
If you have a CVC, infection is a serious potential complication. An infection can lead to blood poisoning, shock or even death.
Central venous line infections become established when a thin slimy film, called biofilm, collects on the internal and/or external surface of the catheter. The two most common bacteria, that make up a CVC-related biofilm are Staphylococcus aureus and Staphylococcus epidermidis. iv Both of these bacteria are commonly found on your skin.
If it’s suspected you might have a CVC infection, blood cultures will be drawn from separate sites and antibiotics will be prescribed.
A CVC is not recommended for most people as a permanent method to provide dialysis access due to the potentially serious central venous catheter complications that can arise. However, for those needing immediate access, a CVC may be the best option – even if it’s a temporary solution.
i McGee, D.C., and Gould, M.K. (2003) Preventing complications of central venous catheterization. New England Journal of Medicine 348:1123–33.
ii Bowdle, A. (2014) Vascular complications of central venous catheter placement: Evidence-based methods for prevention and treatment. Journal of Cardiothorac Vascular Anesthesia 28:358–68.
iii Vats, H.S. (2012) Complications of catheters: Tunneled and nontunneled. Advances in Chronic Kidney Disease. 19:188–94.
iv Kornbau, C., Lee, K. C, Hughes, G. D., and Firstenberg, M.S. (2015) Central line complications. International Journal of Critical Illness and Injury Science 5(3): 170–178.