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Central venous catheters. Observations on the implantation technique and its complications.

The growing utilization of central venous catheterism is linked to the necessity of treating with an always larger number of hospitalized and nonhospitalized patients. The technological development provided us with different devices and materials for specific indications. In the majority of cases the central venous catheter is positioned through direct puncture of a central vein using Seldinger method. The vessels used for the catheterism are: the internal jugular vein, the subclavian vein and femoral vein. The choice of the vein to use is influenced by the operator's experience and by factors depending on the patient. The internal jugular vein via posterior or median and the subclavian vein via subclavicular are the most used sites in the central venous catheterism. However, also the femoral vein can be considered a resource when the clinical conditions of the patient render problematic the positioning in the above mentioned sites. The positioning into the internal jugular vein is generally burdened with a very low risk of pneumothorax and other potentially dangerous complications for the patient. The femoral vein is generally burdened with a larger incidence of thrombosis and infections. The subclavian vein, even if it is the most used, is burdened with a larger incidence of immediate or retarded pneumothorax and accidental venous puncture. The most frequent immediate complications for catheterism are the arterial puncture, pneumothorax, arrhythmias and the wrong positioning. Among the late complications there are the catheter infections correlated, catheter and vessel thrombosis. The use of a proper technique, completed by the operator's experience and the right management of the device, lead to a decrease of the risk level related to the central venous catheterism.