The goal of vascular access devices is to find the best way to administer the therapies required to help the patient recover while doing the least amount of damage to the patient’s vascular system.
Veins: In order of preference, the veins which are commonly accessed are:
Peripheral venous access:
Central venous access:
Venous access is introduction of a needle into a vein.
Venous access is usually used for the purpose of withdrawing blood or administering fluids or medication.
There are a variety of options available for venous access.
These are broadly divided into:
These are tailored to each patient’s needs and to the type, duration, and frequency of infusion.
Peripheral venous access is a simple, inexpensive way of venous access used for short-term IV therapy.
Veins are typically accessed in the patient’s hand or arm, and sometimes in the foot.
Infiltration and phlebitis increase dramatically with increased catheter dwell-time, due to small caliber veins.
These cannot be used for more than a few days.
These can be avoided by
Central venous access is recommended if the IV access is needed for more than a few days. It is cost effective and avoids the risks associated with the peripheral venous access.
The indications for central catheters include the following:
When a catheter or line which are a long thin plastic tubes are placed by entering into a vein in the arm, neck or front of chest and extending into a central vein next to the heart is called central venous access.
Central venous access catheters can be placed by accessing the veins in the neck, chest, groin, lumbar, hepatic or through veins in the arms (also known as a PICC line, or peripherally inserted central catheters).
These are central venous catheters most commonly inserted via the basilic, brachial, or cephalic veins with the tip lying in the central veins next to the heart.
Easy and safer insertion.
Common indications include:
Parenteral delivery of
Require frequent flushing and dressing changes, and the insertion site should not get wet.
For central insertion, preferred veins include the internal and external jugular.
Although access to the subclavian might be technically easy using bony landmarks in the absence of ultrasound guidance, it is generally not advised to place VADs directly into this vein owing to the relatively high incidence of venous thrombosis and the increased risk of catheter damage or fracture associated with subclavian lines.
The 3 main types of centrally inserted catheters are:
These consists of a catheter attached to a reservoir that is implanted into a surgically created pocket on the chest wall or upper arm. A needle is inserted through the port’s septum to access the reservoir.
A local anesthetic is used to temporarily numb the skin at the site of access. There might be pricking sensation to start with, after a few seconds it should become numb.
Most of these procedures can be performed using local anesthetic. However, depending on the case and safety some sedation can be given which makes patient a little sleepy.
In extreme cases, anesthesia support is taken to perform the procedure.
A Radiologist is a doctor who is specially trained in using the X-ray equipment and ultrasound scanner to guide him or her during procedures can perform these procedures.
Alternatively, a specially trained nurse or a surgeon may carry out the procedure.
The procedure is carried out in a specially designed room which has X-ray and Ultrasound scanning facilities as well as patient monitoring equipment.
Depending on the type of vascular access, sedation, monitoring requirements, these procedures can last for about 15-60 minute. Some might take longer depending on the complexity of the case.
Any intervention has got its own risks and it depends on the complexity of the case.
Few of the risks associated are classified into
Most of the these are visible at their entry site, how ever these can be covered to avoid visualization.
Implanted catheters like portcath are not visible outside.
Depending on the type of the vascular access device and type of needs, these can stay for few days to months to years.
Aside from knowing that they have the catheter, these should normally not interfere with day to day activities.