The Ins and Outs of Venous Access

March 25, 2008 by  
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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.


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:



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.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.