Vascular Perforation And Central Venous Catheters

Vascular perforation is an unusual complication. In this article, you can learn more about the different types of catheters and what can cause this rare problem.
Vascular perforation and central venous catheters

Central venous catheters can cause damage to the surrounding structures if not placed properly. Vascular perforation can occur, for example, if the tip of the catheter is misplaced. Fortunately, vascular perforation is an unusual complication. Only 10% of perforations take place in the central veins.

However, when it does occur, it is usually not diagnosed until it is too late and therefore can be dangerous. Therefore, we need to take a closer look at this damage and how to detect it.

Vascular perforation: The different types of central catheters

The design of these catheters thus extends into the largest central vein near the heart. Catheters can vary in size, length and number of channels, depending on their intended use.

A person with a catheter

Taken together, these are the primary types of vascular catheters:

Centrally peripheral insertion catheter

This is a long catheter that extends into the largest vein near the heart from a vein in an arm or leg. It is also referred to as a “midline catheter” 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 vein.

Catheter without tunnel

The central catheter without tunnel can have a larger caliber and is intended to be placed in a relatively large vein. This includes a central vein such as the jugularis , in the neck, in the femur or in the crotch.

Tunneled catheter

This catheter may contain a part that stimulates growth tissue, which helps keep it in place in the body. There are tunneled catheters in different sizes and types. Its safety and easy access are some of the primary features of a tunneled catheter.

Catheter port

This is a permanent device consisting of a catheter connected to a small reservoir.

Ultrasound is often used to evaluate and identify the appropriate vein where a catheter can be inserted. This allows the radiologist to identify them more quickly.

The risks of vascular perforation

The chosen diagnostic test when it comes to vascular perforation at a central level is computed tomography (CT).

There are two types of risks that are directly associated with vascular catheters:

  • Those that occur during placement.
  • Those that occur while the device is in the body.

Some of the risks are:

  • Infection at the incision shortly after the catheter has been inserted.
  • Risk of bleeding.
  • Pneumothorax  or an accumulation of air in the chest that can lead to lung collapse. This can occur while inserting the catheter through a vein in your chest or neck. However, it does not occur with arm veins. 
  • Rarely, the catheter can enter an artery instead of a vein. If this happens, the doctor must remove it. Most of the time, the artery will heal on its own, although it may occasionally require surgical repair.
Vascular perforation can cause infection

Infection due to vascular perforation

When a vascular catheter is used, two types of delayed infection can occur:

  • A skin infection at the opening of the catheter.
  • An infection in the bloodstream.

When the doctor does not attach the catheter properly to the skin, there is a risk that it will fall out accidentally. If this happens, apply pressure to the incision with a sterile bandage and alert your doctor as soon as possible.

We should also note that any type of vascular catheter can become clogged with a blood clot. You can treat the plug with a blood thinner, but sometimes your doctor will need to remove the catheter.

The most obvious sign that there is a problem with the catheter is if one has a feeling of irregular heartbeat. If you experience this, contact your doctor immediately, but overall, catheters are safe.

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