Central venous access devices (CVAD) are intravenous catheters that terminate (end) in the superior vena cava just above the right atrium of your heart.
Venous access devices could be either single lumen or multiple lumens. They can be in place in the short term or long term. Short term use is usually up to 3 weeks. Long term use can mean weeks to months.
Why are they used?
- Intravenous therapy required for more than 7 days
- Poor venous access – difficult to find veins to access
- Infusions of vesicant or irritant chemotherapy
- Where multiple venous access sites are needed
- Total Parenteral Nutrition (TPN) and other hyperosmolar solutions
Types of central venous access devices
- Peripherally Inserted Central Catheter (PICC)
- Non-Tunnelled Catheter (CVC)
- Tunnelled Central Venous Catheter (Hickman)
- Implanted Port (Port-A-Cath)
Above: Peripherally inserted central catheter (PICC)
Peripherally inserted central catheter (PICC)
A PICC line is a soft, small, long, hollow tube that is placed into a large vein in your upper arm just above the bend of the elbow. The PICC line travels up through the vein inside your arm into a larger vein just above your heart.
A PICC line can be inserted in the radiology department, operating theatre, patient’s bedside, or a unit procedure room. It is usually done under local anaesthesia. The PICC line is put in by a doctor.
PICC lines are considered if treatment will be from a week up to 6 months. If anticipated therapy is going to be longer, either a tunnelled catheter or implanted port should be considered.
Management
- Dressings and cap changes need to be done at least once per week
- They need to be flushed at least once per week
- To be removed they can be pulled out by an experienced nurse
Above: Central venous catheter or a non-tunnelled central venous catheter (CVC)
(Central line) Non- tunnelled central venous catheter
Non-tunnelled CVCs can be inserted via the subclavian, jugular, or femoral veins (avoid using the femoral vein in adults) with the tip positioned in the superior or inferior vena cava. Attachment of the external portion may be via sutures or an external fixing device. Non-tunnelled CVCs are short term catheters and should be removed as soon as they are no longer required.
Non-tunnelled CVCs are used in patients who have acute illnesses.
Management
- Dressings and caps on the lines need to be changed at least once per week
- Each lumen of the line needs to be flushed once per week
- They can easily be removed by being pulled out once there is no further use for them
Above: Hickman line
Hickman line
Tunnelled catheters are intended for patients who may require longer-term central venous access.
A Hickman is a central line catheter that is placed on the right side of the chest wall. A Hickman line is a soft, small, long, hollow tube that is placed into a vein in the chest and ends in a larger vein just above your heart. These are like the non-tunnelled except that the outer exposed part is surgically tunnelled through subcutaneous tissue to an exit site generally on the chest or abdominal wall.
The patient will have one to three tubes dangling from the site which will either be sutured in or a device that looks like a sticker will be used to keep it in place. The lumens are short, small tubes with caps at the end.
A tunnelled CVAD is inserted by a surgeon or an interventional radiologist under anaesthesia or light sedation. It will usually take 7-10 days to heal.
Management
- This will depend on the policy at the hospital.
- They usually need to be flushed one per week.
- Caps on the end of the line generally need to be changed at least once per week
- To remove the Hickman line, this will need to be done surgically with a clinician who is experienced with this.
Above: implanted venous port-a-catheter
Implanted Venous Port (Port or Port-A-Cath)
An implanted venous port is a device used for long-term intermittent central venous access via a port implanted into a subcutaneous pocket. It is made up of a reservoir attached to a soft, small, long, hollow tube. The reservoir is placed under the skin and the tube is placed into a vein. The reservoir will look like a bump under the skin. The tube is not usually noticeable.
An implanted venous port is inserted by a surgeon or an interventional radiologist under anaesthesia or light sedation.
It usually takes around 7-10 days to heal. If the port needs to be used immediately, the surgeon can access it and leave the needle in when it is put in. Otherwise it may be too swollen to access for about a week.
Management
- When the port is needed to be accessed, it is done so with a needle called a ‘gripper’ needle
- A gripper needle can remain in for one week before they need to be changed
- Once treatment has completed and the port is de-accessed the gripper needle is removed
- Prior to being removed the port is ‘heplocked’, where heparin (anti-clotting drug/flush) is injected into the port that will stop the port from clotting or blocking
- The port needs to be accessed, flushed and heplocked at least every 4-6 weeks
- The best thing about a port is that they can remain in for many years and once the gripper needle is removed there is nothing hanging from the port and the skin acts as a protection from infection
- When a port is removed, this is a surgical procedure (day procedure)
Contact your doctor or nurse if you have:
- A temperature of 38 degrees or higher
- Shortness of breath
- Chest pain or fast heartbeat
- Redness, pain, swelling, bleeding, or fluid leaking from or around your PICC line or CVC line
- Redness, pain or swelling in your arm, neck, or chest area
- Damage or a break or split in the PICC line or CVC line
- A burning sensation or swelling around the port during your treatment, or at any time.
