Catheters & Ports
What are Vascular Access Procedures?
A vascular access procedure involves the insertion of a flexible thin plastic tube, or catheter, into a blood vessel to
provide a painless way of drawing blood or delivering drugs and nutrients into a patient's bloodstream over a period of
weeks, months or even years.
A simple intravenous (IV) line is effective for short-term use, but is not suitable for long-term use. When an IV line is
necessary for a longer period of time and/or a more secure venous access is necessary, a special catheter, called a
central access catheter, or a similar device is placed inside a major blood vessel either temporarily (days) or long-term
(weeks to years) so that it can be easily and repeatedly accessed over a desired period of time.
In a vascular access procedure, a special catheter is inserted inside a major vein (generally in one of the large veins in
the neck, chest or arm) extending into the large central vein near the heart.
Vascular access procedures are performed when patients need:
Intravenous antibiotic treatment.
Chemotherapy, or anti-cancer drugs.
Long-term intravenous (IV) feeding for nutritional support.
Repeated drawing of blood samples.
Hemodialysis - a process used to treat patients whose
kidneys are not working properly. It involves a special
machine and tubing that removes blood from the body,
cleanses it of waste and extra fluid and then returns it
back to the body.
In contrast to the catheter used in a standard intravenous (IV)
line, a vascular access catheter is more durable and does not
easily become blocked or infected. These catheters are
designed in a way that they extend into the largest central vein
near the heart.
A catheter is a long, thin plastic tube, about as thick as a strand
Following are the major types of vascular access catheters:
The peripherally inserted central catheter (PICC or "pick") is a long
catheter that extends from an arm vein into the largest vein (superior
vena cava) near the heart and typically provides central IV access
for several weeks, but may remain in place for several months.
These catheters are called “midline catheters” when they are placed
in a way that the tip of the catheter remains in a relatively large vein,
but doesn’t extend into the largest central vein. They may have one
or two lumens and some may be able to be used for CT contrast
injections (manufactured for forceful contrast injections).
Non-tunneled central catheters are larger caliber than PICC, and
they are designed to be placed via a relatively large, more central
vein such as the jugular vein in the neck, the subclavian vein in
the chest or the femoral vein in the groin.
The tunneled catheter is the best choice when access to the vein is needed for long period of time. It is secure and easy
to access. They are more secure and usually work more efficiently than PICCs because of their design (cuff on the
catheter stimulating tissue growth) and larger size. The tunneled catheter has a cuff that stimulates tissue growth that
will help hold it in place in the body. Examples of the tunneled catheter include HICKMAN® catheters, BROVIAC®
catheters and GROSHONG® catheters. There are several different types of dialysis catheters. The port catheter, or
subcutaneous implantable port, is a permanent device that consists of a catheter attached to a small reservoir, both of
which are placed under the skin similar to tunnel catheters.
Note: HICKMAN®, BROVIAC® and/or GROSHONG® are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.
A small, hollow needle and long thin wire, called a guide wire, help the physician position the catheter. Other equipment
that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat
and blood pressure.
In medicine, a port (or portacath) is a small medical appliance that is installed beneath
the skin. A catheter connects the port to a vein. Under the skin, the port has a septum
through which drugs can be injected and blood samples can be drawn many times,
usually with less discomfort for the patient than a more typical "needle stick".
Ports are used mostly to treat hematology and oncology patients, but recently ports
have been adapted also for hemodialysis patients.
The port is usually inserted in the upper chest, just below the clavicle or collar bone,
leaving the patient's hands free.
Following are some of the risks associated with placement of a vascular access device:
Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include
damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
An infection may develop at an incision site shortly after catheter placement. The risk is less if you carefully follow
instructions about caring for the incisions as they heal.
Bleeding (hemorrhaging). This risk can be minimized through a blood test in advance to be sure that your blood clots
normally. If it does not, the procedure may be postponed or you may receive medication or blood products to improve
Very rarely a patient may develop a condition called a pneumothorax, a collection of air in the chest that may cause one
of the lungs to collapse. This may occur during placement of a catheter or port using a vein in the chest or neck, but not
when an arm vein is used. The risk is lessened when catheter placement is guided by ultrasound or fluoroscopy. This is
why these catheters should be placed by an interventional radiologist using appropriate imaging guidance during the
The normal heart rhythm may be disturbed while the catheter is inserted, but this is usually only temporary. The problem
is easily recognized during the procedure and eliminated by adjusting the catheter position.
Rarely, the catheter will enter an artery rather than a vein. If this happens, the catheter will have to be removed. Most
often the artery then heals by itself, but occasionally it has to be surgically repaired.
Two types of delayed infection may develop:
Skin infection at the catheter or port insertion site or bloodstream infection. Infections are least common after placing a
port. The risk of delayed infection can be minimized if you and anyone else who will be handling the device wash hands
before flushing it or cleaning the insertion site. The site should be carefully inspected each time the dressing is
changed. The risk of infection is higher for individuals who have low white blood cell counts.
A hole or break in the catheter may lead to leakage of fluid. Breaks may be avoided by not always clamping the catheter
in the same spot and by never using too much force when flushing it. Two important first aid measures: 1) clamp the
catheter between the damaged part and the skin insertion site; 2) tape a sterile gauze pad to the skin to cover the
break. Catheters rarely fracture inside the body. A chest x-ray will show a fracture and allow removal of the broken
fragment without surgery.
The catheter may become accidentally dislodged. If the catheter is not secured to the skin appropriately, it may come
out. If this happens, you should apply pressure to the incision site using a sterile dressing and call your physician
Air in the catheter is an emergency that may cause chest pain or shortness of breath. You should clamp the catheter
right away, lie on your left side and call 9-1-1. This problem can be avoided by always clamping the catheter before and
after inserting a syringe, and by making sure that the catheter cap is screwed on tightly.
Any type of vascular access catheter may become obstructed by clotted blood or fibrin sheath. You can minimize the
risk by carefully following instructions about flushing the catheter. Once a catheter occludes, or becomes closed off, it
sometimes can be cleared by injecting medication but at other times must be removed or exchanged for a new catheter.
Occasionally the catheter can be stripped by a simple interventional procedure.
If the vein in which the catheter lies becomes occluded (closed off) the arm, shoulder, neck or head may develop
swelling. If this occurs, call your physician immediately. The clot may be treated by a blood-thinning medication, but
occasionally the catheter will have to be removed.
What are the limitations of Vascular Access Procedures?
Although some types of central venous catheter may remain in place for months or even years, most catheters require
replacement after certain time frame because of poor function. The reservoir septum of most types of implanted ports
has a useful lifetime of about 1,000 punctures and so is not suitable for patients who require IV access on a daily basis.
Some patients have very poor veins that are not well suited for catheter placement. This usually happens when these
access veins have been used for a long period of time (years for TPN, etc.). It may be very difficult to find a suitable vein
to place a catheter in these patients, and may require unusual venous entry sites (e.g., through the back or through the
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