this video will help you learn about central venous catheters commonly referred to as a CVC your healthcare team recommends that you have a CVC to help with your treatments it's important to watch this video before the CVC insertion procedure so you understand why a CVC is needed and what to expect there are many benefits to having a CVC for your treatment the CVC can be used throughout your treatment for a long period of time as well as for other medical procedures chemotherapy can be harmful to the smaller veins in your hand or arm having a CVC lowers the risk of problems because the catheter tip is placed in a larger central vein the medical team can use the CVC to give medicines and fluids and may decrease the need to have IVs if you agreed to have a CVC the insertion procedure is done as an outpatient or in a hospital room if you are an inpatient as part of the informed consent process this video describes the procedure and possible problems that could occur with the CVC insertion on the day of your procedure your healthcare team will review this information with you again and answer any questions you have about the procedure and your care after the procedure you will be asked to sign a consent form before the procedure the CVC is a small flexible tube that is inserted into a large central vein it can be used to give fluids chemotherapy and medicines it can also be used to give blood products and for other medical procedures related to your care there are three veins that can be used for a CVC placement including the jugular vein placed in the lower part of the neck above the collarbone the subclavian vein placed under the collarbone in the upper chest area and the femoral vein placed in the thigh and groin area your healthcare team determines which vein is the best location to use based on your medical history Pryor central venous access device placements the CBC type and its intended use and how often and how long it will be used your activity level and preference may also be considered the CVC usually stays in place until treatment is completed your healthcare team will talk with you when it's time to have it removed CBC catheters come in different sizes and with a different number of smaller tubes called lumens which are part of the main catheter each lumen is a separate tube and is used to give treatments or take blood your provider will choose the one that is best for you based on your treatment plan there are risks with any type of procedure or surgery although the risks of having a problem with the CVC procedure are low problems can occur a collapsed lung also called pneumothorax can occur if the needle accidentally punctures the lung while it's inserted in the subclavian or jugular area we perform about 5000 insertion procedures a year and this occurs in less than 1% of patients if a collapsed lung occurs patients may need to be in the hospital for two to four days to heal and may need a small tube placed into the chest to re-inflate the lung a delayed collapsed lung is also a risk this can occur within 24 hours after the CVC is inserted symptoms of a collapsed lung are shortness of breath a cough or chest pain if any of these symptoms occur after the CVC procedure go to the nearest emergency center right away or if you are in the hospital tell your nurse immediately an artery puncture is when the needle punctures an artery instead of a vein during insertion the risk of this is low because ultrasound is used to help guide the needle a punctured artery can cause a hematoma which is when blood collects outside the artery patients are observed carefully for any swelling due to a hematoma we will pressure to stop the bleeding some patients may need surgery to stop the bleeding this is rare nerve injury is another rare risk we use guided ultrasound to reduce the risk of this happening another risk is having an incorrect vein or catheter position sometimes the CVC doesn't go into the correct vein if this happens the CVC is repositioned and the chest x-ray is repeated to confirm the correct position although it's not common some patients may need to have the CVC placed using an image guided x-ray called fluoroscopy other rare problems that may occur after a CVC insertion include catheter infection arm neck or leg swelling due to a blood clot or damage to the catheter tell your nurse if you are in the hospital or go to the nearest emergency center if you have any of these symptoms or side effects after your procedure in some cases you may have other options available to you instead of having a CVC you can get your medicines through an IV in your arm or depending on the medicine you can take them by mouth or by injection another option is to not take the medicines despite the possible risks your healthcare team believes that the benefits of having a CVC outweigh the risks and recommends that a CVC is the best way to get your treatment and medicines talk with your provider if you have any questions or concerns about the procedure including the risks and other options the CVC insertion is done by a procedural list this person is a healthcare provider with special training to do procedures before your procedure an interview will be done in person over the phone or both to review your medical history to make sure you are able to have this procedure this assessment may show that you need additional lab work chest x-ray or an ultrasound of your veins before the procedure starts the procedure list reviews your medical history and asks health and symptom related questions they will review the procedure and answer any questions you have before you sign the consent form next an ultrasound is done to look at your vein and measure your CBC if you are anxious medicine may be given to help you relax if we do give you medicine to relax you will need to have someone with you for at least three hours after the procedure an adult will need to drive you home in some cases patients with extreme anxiety may need to have their procedure done while under general anesthesia this needs to be arranged in advance and involves a consult with the anesthesia and procedure team for any special instructions next you lie down for the procedure we made tilt the stretcher or bed so that your head is in a lower position than your feet a nurse will clean the skin around the insertion area with a solution that kills germs a sterile cover is placed over your body the procedure list and nurse will ask you if you have any questions and do a final review before the procedure is started a needle is used to numb your skin with a local anesthetic the anesthetic is a medicine that blocks pain during the procedure you will have a burning feeling as the medicine is injected but it will not last long it's common to feel a little discomfort during the procedure if you feel sharp pain or extreme discomfort tell the procedure team right away next a needle is inserted into the vein using an ultrasound to help guide it to the correct location a soft wire is threaded through the needle and into the vein then the needle is removed next a dilator is used to expand the vein this allows the procedure list to thread the CVC catheter over the wire and into your vein you may feel some pressure during dilation and CVC placement then the wire is removed and the nurse stitches the catheter to your skin a sterile dressing is applied over the insertion area after the procedure a chest x-ray is done unless you had a femoral insertion then you'll return to the outpatient procedure area or your hospital room to wait for the results if you are an outpatient do not leave the hospital until the care team gives you the chest x-ray results do not let the healthcare team use your CVC until you are told your chest x-ray is normal it's important that you do not leave the Houston area for 24 hours after the catheter is inserted once your CVC is placed the healthcare team will talk with you about how to care for your CBC a nurse will take care of your CBC if you are a patient in the hospital a nurse from your outpatient clinic area can do your CVC care while you are on-site at MD Anderson for appointments CVC care requires doing weekly sterile dressings and cap changes and routine flushes for maintenance if you will leave the Houston area after 24 hours you or your caregiver must attend a CVC care class before you leave the area if you have any problems or concerns about your CVC care please contact the procedure care team after watching this video it's important that you understand the CVC procedure the benefits and risks and the required routine care and maintenance you must learn how to do home CBC care before leaving the hospital talk with the procedure care team if you have any questions about the information covered in this video you [Music]