Central Venous Access Devices

1. Central Venous Access Devices

2. Objectives The learner will be able to: • Discuss the differences between peripherally inserted versus centrally inserted central venous access devices. • Identify ideal patient characteristics for each type of catheter presented.

3. Types of Intravenous Access Devices • Peripheral intravenous access (IV) • Subcutaneous infusion devices • Midline catheters • Peripherally inserted central catheters (PICCs) • Central venous lines (nontunneled) • Central venous catheters (CVCs) (tunneled) • Implanted ports • Apheresis/hemodialysis catheters

4. Central Venous Catheters • Types of central catheters include: • Percutaneous (nontunneled) • Tunneled • Peripherally inserted (PICC) • Implanted ports.

5. Routes of Administration:PICC • Used for patients with limited peripheral veins and with need for venous access for a limited time (weeks for midline; FDA has approved PICC use for up to 12 months.) • PICC can be used for vesicants/irritating solutions, TPN. • Requires significant patient education to care for at home • Complications similar to those of other central lines

6. CVC: Peripherally Inserted Central Catheter (Reprinted with permission from Lenz Marketing, Decatur, GA)

7. Routes of Administration:Nontunneled CVC • Used for short-term treatment (up to six weeks) • Patients with poor peripheral vein access or have need for frequent venous access • Poor surgical candidate or shortened life expectancy • Critically ill requiring multiple lumens • Are removed when therapy complete

8. Routes of Administration:Tunneled CVC • Open-end distal tip catheters: Require clamping for connection of IV tubing or syringes • Closed-ended two-way pressure-sensitive valve tip catheters: Clamping not required1 • Used for long-term IV access • Percutaneous or cut-down insertion

9. CVC: Tunneled (Reprinted with permission from Lenz Marketing, Decatur, GA)

10. Routes of Administration:Implanted Venous Port • Portal body (septum and reservoir) and catheter • Used for those needing intermittent IV therapy or who do not want to/cannot care for an external line • Good for patients with active lifestyles1 • Ample chest area required2 • Power ports can withstand additional pressure.3

11. CVC: Implanted Port (Reprinted with permission from Lenz Marketing, Decatur, GA)

12. Cross Section of Implanted Port Photo courtesy of Smiths Medical MD, Inc. St. Paul Minnesota. Used with permission.

13. CVC: Peripherally Inserted Implanted Port (Reprinted with permission from Lenz Marketing, Decatur, GA)

14. References Camp-Sorrell, D. (Ed.). (2011). Access device guidelines: Recommendations for nursing practice and education (3rd ed.). Pittsburgh, PA: Oncology Nursing Society. Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.). Pittsburgh, PA: Oncology Nursing Society. Smith, L. (2008). Implanted ports, computed tomography, power injectors, and catheter rupture. Clinical Journal of Oncology Nursing, 12, 809812.