Types of Central Venous Access Devices

   

  1. Peripherally Inserted Central Catheter – PICC
  • provide alternative IV access when the patient requires intermediate-length venous access
  • Therapy length = 7d – several months
  • inserted in the antecubital fossa into the cephalicor basilic
  • central catheter is inserted and threaded through the peripheral catheter
  • distal catheter tip lies in the superior vena cava
  • 16-24 gauge
  • 40-65cm long, determined by distance from insertion site to superior vena cava
  • placement must be radiologically confirmed.

2. Nontunneled percutaneous central venous catheter

  • inserted through skin into the internal or external jugular, subclavien or femoral veins
  • therapy length = 5-10 days
  • catheter tip rests in the superior vena cava
  • 15-20cm long
  • has 1-4 lumens

 

3. Tunneled Central Venous Catheters

  • surgically inserted, tunnelled through subcutaneous tissue between nipple and clavicle
  • a central line that is tunneled under the skin so that the exit site is away from where the catheter enters the blood vessel
  • has free-hanging line
  • does not have antireflux valve like PICC
  • catheter tip rests in the distal end of the superior vena cava
  • Therapy duration: months to years
  • stabilised by dacron cuff and resulting granuloma tissue at site
  • granuloma tissue creates an antimicrobial barrier between the skin and venous system.
  • Eg Hickman, Broviac, Groshong

 

4. Subcutaneous implanted ports

  • Therapy duration: Long-term complex IV therapyeg . Port- A- Cath
  • consist of a portal body, central septum reservoir and catheter
  • single or dual ports available
  • infusion port is surgically implanted in a subcutaneous pocket in the chest, arm, forearm or abd wall
  • the catheter is threaded into the superior vena cava
  • the port is easily palpatable to assess placement
  • Assess of the port is through noncoring Huber needles inserted through the skin
  • Herparin flushed q4wks to maintain patency
     
  • similar to a tunneled catheter but is left entirely under the skin.
  • Medications are injected through the skin into the catheter.
  • Some implanted ports contain a small reservoir that can be refilled in the same way.
  • After being filled, the reservoir slowly releases the medicine into the bloodstream.
  • An implanted port is less obvious than a tunneled catheter and requires very little daily care.
  • It has less impact on a person’s activities than a PICC line or a tunneled catheter.
     
    Potter and Perry. 2006. Clinical Nursing Skills and Techniques. 7th ed. Elsevier.
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