Medical Technology News Focus CVC

Central Venous Catheter

Intended use

Continous or intermit venous treatment.

　Infusion of liquid or blood

　Monitoring of the CVP

　Frequent blood draws

　Parenteral nutrition

　infuse irritative liquid.

　multi lumen for different drugs,those may be interacted.

Applications

麻醉科（OR）

重症监护室（ICU）

肿瘤科(Oncology)

急诊科(Emergency)

普外科(Surgery)

神经内科(Nerve)

血液科(Hemocology)

Configuration

• Central Venous Catheter

• Guidewire with advancer

• Syringe

• Introducer needle

• Tissue dilator

• Injection cap

• Injection needle

• Fastener

• 

Features 

soft tip----melted with tube, no migrate, the tender and soft tip minimize the trauma to vascular vessel.

Material of tube-PU（Medical grade Polyurethane）

Features：

 1. soft and elasticity，after insertion into body, it will become soft of 50% under body temperature(37°C). 

form according to the form of blood vesel, reduce the trauma and anti-kink.

2. tube is smooth to avoid the thrombosis。

3. marking of scale eanable physcians to insert the catheter according to the length。

4. The radiopaque tube and tip facilitate catheter location when visualized by X-Ray.

*Tube vessel is thin,and smooth, there are very limited impact on the blood flow.

Special PU material

1.the thrombosis can not occur

2.irritation of blood vessel is rare

*Round hub can reduce the friction between tube and skin, make patients more comfortable.

*Luer Lock—international standard，Suitable for all connector。

*Extension Tube—made from PU，inside of the tube is smooth and elastic. good for clamping and pressure tranfering.

*Clamp—made from medical grade PP. It's elastic and anti-kink，and suitable for frequently moved, and avoid airbubble.

fixation wing made from PP or siliconed rubber.

Introducer needle—18 Ga straight or Y-shape needle；inside of needle is thin，

available valve to avoid air entering or blood leaked.needle is sharp and smooth inside enable the guidewire pass smoothly.

the arrow mark on the needle hub indicate the direction of insertion of needle and guidewire.

End of hollow syringes for insertion of guidewire——To avoid airbubble and blood leak

Guidewire—0.018“~0.035" diameter，J tip (two ends are soft)，surface is smooth with good elasticity and scale marking,

 which is easy to monitor the depth of insertion. Guidewire, introducer needle and dilator are easily work together

Guidewire advancer—work with guidewire flexibly，

Guidewire advancer is designed according to somatology, available lock to avoid drawing back of guidewire

J shape and soft tip,

can avoid trauma to blood vessel.

bulge--

make insertion guidewire easier.

Dilator: good elasticity，moderate hardness，smooth inside and outside，good compability with guidewire ．

Specification

Normal specification

Adult: Single Lumen(14Ga, 16Ga)

           Double Lumen(7Fr, 8Fr)

           Triple Lumen(7Fr)

           Quad Lumen(8.5Fr)

Child: Single  Lumen(18Ga)

           Double Lumen(4Fr, 5Fr)

           Triple Lumen(4.5Fr, 5.5Fr)

Infant: Single Lumen(20Ga, 22Ga)

L: 5,8,13,16,20cm or customerized ranges from 5 to 30cm.

Clinical use

Three puncture sites

1. Jugular

2.Subclavia

3.Femora

catheterization procedure

1) Place the patient in a trendelenberg position (15 to 30 degrees head down) to reduce the chance of an air embolism, 

turn the patient’s head to the side contralateral to the site chosen.

2) mark puncture site  

3) Anesthetize the spot by using needle, the angle between needle and skin shall be 30 to 45 degrees.

4) when a flush of blood returns by advancing the needle, insert venous needle. 

Remarks: pay attention to the direction of needle and color of blood 

returns during advancing seeker needle , meanwhile, pay attention to 

the direction of needle and depth of puncturing needle , the bevel of 

needle shall be faceup.

5) one hand hold the needle，another hand hold the syringe ,keep the pressure negative during the slow insertion. 

When you feel the needle placed into the vein, the blood will return smoothly.

6) Guidewire will be inserted through Y shaped syringe or hollow syringe.

Remarks: during the insertion of guidewire，please judge  the resistence , don't withdraw 

the guidewire by force, withdraw the guidewire together with syringe if ncessary.

7) withdraw syringe, and insert dilator by 1-2 cm  under the skin for enlarge the track.

Remarks: During insertion of dilator, attention shall be paid to the direction and the force of dilator, 

specially the force transfering between dilator and guidewire, the driving force shall be increased gradually  

Withdraw the dilator, implant the catheter from the end of guidewire, and saline shall be injected into to the catheter immediately. 

Ensure the whole catheter implanted completely and then fixed the catheter at the final position.

Connect  with other tubes and devices

The force for inserting the catheter is related to enlarging of the track, if the resistence is big, the length of each insertion shall be shorter , 

and attetion shall be paid to avoid kink of guidewire. 

Kink of guidewire due to improper operation

1. kink occurs within 5cm of insertion: the normal cause is incomplete insertion of bevel of needle into vein .

2. Kink occurs between 5 cm and 10 cm of insertion: the normal cause is  the incorrect insertion of needle, 

which is inserted into small vein or muscle instead of vascular vein the reason is dislocation of spot and improper angle of puncturing.  

80% of kink issues belong to this case. 

3. The kink occur between 10 cm to 15 cm,  the reason is that the force   of driving guidewire and enlarging force of dilator is too 

4. Kink rarely occurs after 15 cm insertion.

The factors and measures 

General infections caused by catheter itself, such as: not follow Non-bacterial operation strictly. Nutrition liquid, 

the contact between catheter and skin of exit site, overtime exposure of catheter. Germiculture for tip of catheter 

shall be conducted if necessary, glove shall be used during the insertion and care.

Nursing care

The factors cause blockage of catheter ：

1. mechanical factors  

2. non-embolism factors  

①continuous infusion , the change of body position cause return of blood. 

② infusion of blood products in case of part of catheter blocked ，accumulated Fibrin    make lumens smaller, even complete blockage. 

3. patients’ factor: blood viscosity increase 、blood stasis in vein, return of blood, overtime of measurement of CVP,

 increase of intracranial pressure. Frequent vomit ,cough and hiccup.

4. Catheter’s factors 

5 . the choose of puncturing site 

    Embolism factors: trauma、irritation or other pathological factors change the vessel of vein.    

  types: ①Fibrous sheath: fiber gathers on the surface of catheter, sheath is formed at the end of catheter

　　       ②Fibrous valves: fiber gathers at the end of catheter ,one way valve is formed, which allow liquid infusion and prohibit return of fluid. 　　     

             ③vessel attached embolism: the fiber at the damage of vessel gathered surface of catheter. 　　       

             ④embolus in catheter :embolus formed inside of catheter, and block the holes. 

Leakage of hollow syringe ：

There is difference between front end of hollow syringe and the taper of  hub of needle. 

The connection between front end of hollow syringe and the hub of needle is not firmed.

There is difference between handspike's rubber and Cylinder.

Leakage of catheter

Defective material (outsourcing).

Technics of each part’s connection. 

Physical damages to catheter during the operation.

Infuse hyperosmotic and corrosive medicine. 

Insufficient  flow rate:

The inside surface of catheter may not smooth or with flash.

Lumen side become narrow because of over indwelling time and lost of heparin.

The puncture site not match the length of catheter 

The side holes was touched by Venous valve( femoral)

Infection（infection caused by multi factors）

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