The Ins and Outs of Venous Access

Why a venous access device?

Venous, meaning vein, is the fastest route for delivering medication, blood and blood products in a consistent and safe and efficient manner.

TYPES OF VENOUS ACCESS DEVICES

The peripheral line

Peripheral access is obtained using a peripheral vein (hands, arms, feet or legs). Generally the hands and arms are used. Location and placement is determined by the condition of the patient’s veins and the reason for access.

An intravenous catheter is inserted using a needle covered by a flexible sheath. After insertion the needle is removed and the sheath remains inserted connected to a hub. This hub may then be connected to tubing for continuous intravenous therapy (IV) for blood or blood products, antibiotics or other medications. Often when the IV is completed and the site is still is in good condition, the access hub will receive a small cap. The cap will be used to flush the site with saline per protocols and is available for future medication delivery.

A sterile dressing will be placed over the insertion site and the catheter will remain in place for several days. These sites are not used for blood draws.

Central Venous Access Device:

All Central Venous Access Devices involve a catheter tip which rests in the superior vena cava of the heart, except a femoral (groin) line whose tip sits in the inferior vena cava.

X-ray is used to verify the correct placement of all CVADs.

A CVAD is chosen over a peripheral line for many reasons. Many drugs, especially chemotherapy medications used to treat cancer are damaging to small peripheral veins, resulting in the collapse, scarring or occlusion of the site. This leads to multiple sticks for new peripheral access sites. A CVAD will stay in place for a longer period of time, generally for the entire therapy regime or longer and most patients will go home with the device. Patients are then taught how to care for their CVAD devices at home.

A CVAD may eliminate the need for multiple laboratory blood draws.

Today’s CVAD catheter products enable the infusion of several medications, some incompatible, at the same time.

It is important to discuss with your doctor why you are having a CVAD placed. The more you know about your therapy the more comfortable you will be.

Four Common Types of CVAD:

PICC Line

This CVAD is called a peripherally inserted central catheter (PICC) and is non-surgically placed into the antecubital area of the arm (the front surface of the arm, at the elbow). The catheter which has a guide wire is then threaded to rest in the superior vena cava (the top opening of the heart) Several companies make this device. The photo shows a Bard brand PICC line, however; there are other brand names you may hear about such as Poly PICC or Groshong. Note the lumens or pigtails. These lines may be inserted at beside by a specialist nurse or a physician. These lines may be used for laboratory blood draws.

Non Tunneled Central Catheter

This type of CVAD is used more often for emergencies because of the quick access. The catheter is placed in the jugular or femoral vein (femoral vein is in the groin). These catheters are left in place for no longer than 2 or 3 weeks. They are not seen as often because due to the location they are not as flexible for patients and have a higher infection rate and because often cancer therapies last longer than the recommendation placement time of these catheter. They may be inserted at bedside and will have one or multiple lumens (pigtails) for use. After insertion a sterile dressing is placed on the area.

Tunneled Central Catheter

This is a surgically placed catheter. Two incisions are made to tunnel the catheter in through a vein in the chest or neck, and they generally exit above the nipple level of the chest wall. While 8 to 10 inches of the tubing is visible, this catheter is easy to keep in place and much more accommodating for the patient’s lifestyle. The photo shows a Bard brand single lumen Hickman catheter. There are many brands such as Hickman, Broviac, Groshong, each with a variety of specific characteristics. Which catheter you receive will depend on your physician and your particular needs. The tunneled catheter will have a sterile dressing at the insertion site, and will be capped off when not in use. These catheters may be used to obtain laboratory blood samples.

Port Catheter

This CVAD requires surgical placement. The port may be placed in the upper chest, or a smaller type of port may be placed in the forearm. The photo shows a Bard port. There are many brand names such as Mediport, Infusaport or Port-A-Cath. The catheter is placed under the skin in a small pocket. The incision is about two inches long and the catheter portion is tunneled like the tunneled catheter. Once the incision heals it is difficult to tell the you have a catheter. The reservoir sits below the skin. Its surface is covered with a rubber top. When your port is needed a special needle called a Huber needle is used for access. When the needle is in place the site will be covered with a sterile dressing. Ports may be used to obtain your laboratory blood samples.

Resources for venous access ports:

Central Venous Access Device photos are from Bard, where you may also obtain patient information on access devices.

Other resources:

PICC line education from a nursing PICC insertion specialist.

Teens Living with Cancer, All Hooked Up: Central Lines

RadiologyInfo: Vascular Access

HDC Corporation, The original PICC company, for product information.