Types of Central Venous Access Devices
- 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.