Patients with a central venous catheter used to be scary to me. Not in a way that I was afraid of them, but I was always thinking you mustn't do anything wrong. One mistake and it could have a strong effect on them as the catheter ends in the right atrium of the heart.

On my first day of my internship on the orthopaedic ward I had to care for a patient with a central venous catheter. I felt just the way as I've described above. The reason why this patient had a central venous catheter was because she needed 6 times a day antibiotics over the veins. Antibiotics are quite aggressive towards blood vessels. It could lead to an inflammation of the vein, a so called phlebitis. That means, someone with a high dose of antibiotics won't get it over a catheter placed in a vein of an arm but over a central catheter.

I've learnt that over a central venous catheter you not only can apply antibiotics or other drugs, but also taking blood samples easily. You won't waste time searching for good veins to withdraw blood, or hurting the patient unnecessary with a needle stick.

Usually patients get the central venous catheter intraoperative. That means surgeons place the catheter just in front of the right atrium of the heart while the patient is under anaesthesia.

To preserve a central venous catheter there must be a minimum of infusion passing through. If the catheter is blocked, you can try to flush with 10 millilitre injection of a 0.9% sodium chloride solution. If flushing is impossible, you need to contact the doctor. He decides if you need to remove the catheter or what else you could do.

In the case of removing the catheter you need to be careful to remove the whole catheter with its top. If the top is missing, it could lead to an embolism, an occlusion of a blood vessel, caused by the small top of the catheter. Afterwards you need to compress for about 5 minutes the point where you've removed the catheter, to prevent from bleeding. Alternatively you could put a sandbag on the removal point.

These were just some impressions I've made so far while working with patients with a central venous catheter. I think the central venous catheter is a very interesting subject, which should be treated carefully. I guess the more experience I get with the handling of central venous catheters, the less scary the subject will be once.