Central venous pressure (CVP) lines are used to monitor central venous blood pressure. They are commonly inserted into the central veins, usually in the jugular vein in the neck but can also be inserted in the subclavian or axillary in the chest or femoral vein in the groin. Central venous pressure lines are used during major surgery or for patients in intensive care. The normal central venous pressure is between 2-6 mmHg.
Complications from a central venous catheter are rare, however the following reactions have been documented:
- Infection
- Pneumothorax
- Intrapleural infusion
- Haemothorax
- Arterial puncture
- Intrapleural infusion
- Haematoma
Complications can present immediately or after surgical procedures. These can have a detrimental effect on the patient as they could result in longer hospital admissions, further treatment and suffering avoidable pain. It is important that the risks and complications of CVP line insertion are explained to the patient to ensure they are correctly consented under Montgomery v Lanarkshire Health Board [2015] UKSC 11.
Many of the previously mentioned complications are as result of the CVP being mispositioned, it is therefore the duty of the clinician to undertake this with the upmost care. Any issues that arise such as failed insertion or a mispositioned line should be sufficiently documented and escalated if necessary. If errors are left undocumented then this can give rise to litigation. For example, if a left jugular CVP failed but then successful CVP was inserted into the right jugular, the clinician should document this failed attempt and check for any signs of needle trauma such as bruising or swelling as this could be indicative of a haematoma. Another way to prevent these complications is to ensure another clinician is present e.g. a nurse who can assist in monitoring the procedure and assess the patient for complications.
Advances in technology such as ultrasound guidance have been introduced to help to ensure that CVP lines are inserted correctly and reduce the chance of complications
To summarise, although the insertion of CVP lines are a common practice, like all medical procedures they carry risks which can result in significant injuries. In order to avoid patient harm and litigation, healthcare professionals should monitor patients and ensure they observe and communicate any issues with the rest of the care team to ensure that corrective treatment can be provided should this be necessary.
