Which device?

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

The major advantage of a central venous access device (CVAD) is that it allows easy access to a patient’s circulation over a long period of time. This gives added comfort to the patient who no longer has to undergo repeated venepuncture. The nature of the CVAD also enables the patient to return home between treatments, with the exception of central lines.

The selection of the most appropriate CVAD for each individual patient may reduce the risk of subsequent CVAD related complications. The most appropriate CVAD will be selected by the clinician referring the patient based on a clinical risk assessment, therapy required and duration of treatment.

Central venous access devices are used for patients who require multiple infusions of fluids including cytotoxic therapy, blood products, drugs or total parental nutrition (TPN). They also provide easy access for routine blood tests.

Please note this guideline does not cover the care and maintenance of midlines. A separate guideline can be found by clicking the following link: G124 Care and maintenance of Midline Catheters

Central venous access devices (CVAD)

The term CVAD refers to an intravenous catheter whose internal tip lies in a large central vein. There are various different types of CVAD but common to all is the idea that the tip of the catheter floats freely within the bloodstream in a large vein and parallel to the vein wall.  Blood flow around the catheter is maximized and physical or chemical damage to the internal walls of the vein are minimized.

Opinions vary about the ideal place for the tip of a CVAD but it is generally accepted that the internal tip should be in one of the following positions:

  1. superior vena cava
  2. junction of the right atrium and the superior vena cava (also known as the atrio-caval junction)
  3. right atrium.

CVAD tip position:

CVAD trip
Photo source: Bard Access Systems

Central lines

Central lines can be used:

  • only as an inpatient
  • short term until not needed or when a definitive CVAD is inserted
  • when patient has poor access
  • multi-lumen needed g. in ITU (each lumen must be accessed using an aseptic technique). Access is required to administer IV irritants, vesicants, long term antibiotic therapy, total parental nutrition (TPN), blood products.

 NB Central lines are not used to deliver chemotherapy

Central line

Figure 1: Central line.

Peripherally Inserted Central Catheter (PICCs)

PICCs are versatile and can be used when:

  • repeated blood samples are required
  • intravenous (IV) therapy is required from 6 weeks to 12 months
  • treatment is given as an in-patient or out patient
  • access is required to administer IV irritants, vesicants, long term antibiotic therapy, TPN, chemotherapy, blood products and to obtain blood samples.

Venous access for PICC placement is usually via the basilic or cephalic vein.

PICC

Figure 2: PICC line

Hickman line

A Hickman line is inserted when:

  • PICC insertion is not advisable or has failed
  • venous access is required from 6 weeks up to 2 years
  • access is required to administer IV irritants, vesicants, long term antibiotic therapy, TPN, chemotherapy, blood products and to obtain blood samples.

Hickman line

Figure 3: Hickman line

Portacath (port)

A totally implanted port (port) is an implanted device comprised of a portal body and attaching catheter which are implanted under the skin and designed to provide repeated access to the venous system. The port is made of stainless steel, titanium or plastic that has a hollow reservoir with a latex septum and a side outlet that connects to a silicone or polyurethane catheter which will lie directly in one of the central veins.

The PowerPort* device is the first MRI safe port which is indicated for power injection when used with the PowerLoc* safety infusion set.  It combines reliable venous access with the unique ability for power injected Contrast-Enhanced Computed Tomography (CECT) scans.

The main advantage of ports over other CVADS is that they are implanted and therefore, not external to the body. Ports can remain insitu for up to five years. Consequently, there is:

  • less of an impact on patient’s body image as the port is not seen
  • less risk of infection as the port is not exposed to life’s daily bacteria
  • the ability to swim and bathe and allow more patient activity,
  • no external dressing to the device
  • no risk of accidental pulling/cutting of the device.

Portacath

Figure 4: Portacath.