If Peripheral Venous Cannulas Have Color Coding, Why Not Central Venous Cannula?

Central venous cannulas (CVCs) are widely used in critical care, anesthesia, and emergency settings. The internal jugular vein is the preferred insertion site due to its lower risk of catheter-related complications.[1] Triple-lumen catheters, featuring proximal, middle, and distal ports, are commonly used as they allow multiple infusions simultaneously. Rapid and accurate identification of catheter lumens is crucial.

The distal port, being closest to the right atrium, is used for transducing central venous pressure waveforms.[2] Inotropes and vasoconstrictors are typically infused through a dedicated line, preferably the proximal port.[3] To prevent complications, flushes and bolus drug administrations are avoided through the inotrope port. Additionally, knowing the distal port's location is essential for inserting a guidewire when replacing a CVC.

Currently, no standardized color-coding system exists for CVCs in India, leading to an increased risk of medication errors and line confusion. [Fig. 1] illustrates the variety of CVCs available at our institution alone, and clinicians across different hospitals encounter even more variations in port colors.[4] [5] [6] [7]

Fig. 1 Color coding variations of central venous cannulas.

Establishing a standardized color-coding system would enhance safety and promote uniformity across health care facilities, like the one widely recognized for peripheral venous cannulas ([Fig. 2]). We urge regulatory bodies and manufacturers to collaborate in developing and implementing a standardized CVC color-coding system.

Fig. 2 Peripheral venous cannula with standard color coding for the respective sizes.

We also suggest incorporating additional features, such as tactile identification of ports, to improve accessibility for health care providers with color vision deficiencies. Such a dual verification system, providing visual and tactile cues, can enhance safety in low-light emergency situations. Further, introducing noncompatible connectors that physically prevent incorrect connections to high-risk ports may mitigate risk. Thus, combining shape-based differentiation with color coding would create a multisensory safety system, potentially reducing the likelihood of medication errors.

 

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Conflict of Interest

None declared.

Authors' Contributions

M.S. contributed to data curation, writing—original draft, gave final approval, and agrees to be accountable. S.R.C. contributed to conceptualization, writing—review and editing, gave final approval, and agrees to be accountable.

Patients' Consent

Informed consent was obtained from the patient.

• References

• 1 Rupp SM, Apfelbaum JL, Blitt C. et al; American Society of Anesthesiologists Task Force on Central Venous Access. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2012; 116 (03) 539-573
• 2 Barker C, Lake KJ, Jefferson P, Ball DR. Monitoring central venous pressure: a survey of British intensive care units. Anaesthesia 2008; 63 (10) 1150-1150
• 3 Parry A. How to administer inotropic drugs. Nurs Stand 2015; 30 (04) 36-39
• 4 PowerLine™ Central Venous Catheter | BD [Internet]. Accessed May 13, 2025 at: https://www.bd.com/en-us/products-and-solutions/products/product-families/powerline-central-venous-catheter
• 5 Certofix® Trio | B. Braun [Internet]. Accessed May 13, 2025 at: https://catalogs.bbraun.com/en-01/p/PRID00000570/certofix-trio?bomUsage=overview
• 6 Central Venous Catheter [Internet]. BAIHE MEDICAL EUROPE. Accessed May 13, 2025 at: https://www.baihemedical.eu/central-venous-catheter/
• 7 Lepu Medical Safecath Plus Antimicrobial Central Venous Catheter Kit Manufacturer [Internet]. Lepu Medical Technology (Beijing) Co., Ltd. Accessed May 13, 2025 at: https://en.lepumedical.com/products/safecath-plus-antimicrobial-central-venous-catheter-kit/

Publication History

Article published online:
26 June 2025