Central vascular Access Central vascular Access DevicesDevices

Nicola YorkNicola YorkClinical Nurse Manager Vascular AccessClinical Nurse Manager Vascular Access

Oxford Radcliffe Hospitals NHS TrustOxford Radcliffe Hospitals NHS Trust20082008

Temporary CVCTemporary CVC

Temporary Central Venous Temporary Central Venous Catheters (CVC)Catheters (CVC)

Inserted into internal jugular or subclavain Inserted into internal jugular or subclavain veins (occasionally external jugular and veins (occasionally external jugular and femoral veins)femoral veins)

Usually inserted prior to major surgeryUsually inserted prior to major surgery Catheters are impregnated with anti Catheters are impregnated with anti

microbial –silver sulphonamide and microbial –silver sulphonamide and chlorhexidine. This extends their use to 8 chlorhexidine. This extends their use to 8 days.days.

Catheters have 3-4 lumens.Catheters have 3-4 lumens.

Temporary Central Venous Temporary Central Venous Catheters (cont)Catheters (cont)

Used to administer fluids, blood products, Used to administer fluids, blood products, all intravenous drugs and parenteral all intravenous drugs and parenteral nutrition.nutrition.

Central Venous Pressure (CVP) can be Central Venous Pressure (CVP) can be monitored from the distal lumen.monitored from the distal lumen.

15-20 cm catheter inserted.15-20 cm catheter inserted. Tip of catheter lies in lower third of Tip of catheter lies in lower third of

superior vena cava.superior vena cava. Chest x-ray done post insertion to confirm Chest x-ray done post insertion to confirm

catheter tip position and exclude catheter tip position and exclude pneumothorax. pneumothorax.

PICCPICC

Peripherally Inserted Central Peripherally Inserted Central Catheters (PICC)Catheters (PICC)

Inserted into ante-cubital veins under Inserted into ante-cubital veins under palpation or upper arm veins using palpation or upper arm veins using ultrasound guidance.ultrasound guidance.

45-55 cm catheter inserted.45-55 cm catheter inserted. Catheters have 1-2 lumens.Catheters have 1-2 lumens. Tip of catheter lies in lower third of Tip of catheter lies in lower third of

superior vena cava.superior vena cava. Tip position must be verified on chest Tip position must be verified on chest

x-ray.x-ray.

Peripherally Inserted Central Peripherally Inserted Central Catheters (cont)Catheters (cont)

Used for months, often up to a year.Used for months, often up to a year. Used to administer long term Used to administer long term

antibiotics, chemotherapy and antibiotics, chemotherapy and parenteral nutrition.parenteral nutrition.

Can be used for blood sampling.Can be used for blood sampling. Patients can go home with device in Patients can go home with device in

situ.situ.

Tunnelled CVCTunnelled CVC

Tunnelled Central Venous Tunnelled Central Venous CathetersCatheters

Inserted into internal jugular or subclavian Inserted into internal jugular or subclavian veins (occasionally femoral veins).veins (occasionally femoral veins).

End is tunnelled subcutaneously – can be End is tunnelled subcutaneously – can be cuffed or non-cuffed.cuffed or non-cuffed.

Catheters have 1-3 lumens.Catheters have 1-3 lumens. Tip of catheter lies in lower third of Tip of catheter lies in lower third of

superior vena cava.superior vena cava. Chest x-ray done post insertion to confirm Chest x-ray done post insertion to confirm

catheter tip position and exclude catheter tip position and exclude pneumothorax.pneumothorax.

Tunnelled Central Venous Tunnelled Central Venous Catheters (cont)Catheters (cont)

Used for months, often years.Used for months, often years. Used to administer long term antibiotics, Used to administer long term antibiotics,

chemotherapy and parenteral nutrition.chemotherapy and parenteral nutrition. Can be used for blood sampling.Can be used for blood sampling. Patients can go home with device in situ.Patients can go home with device in situ. Minor procedure to remove cuffed Minor procedure to remove cuffed

catheters.catheters.

PortacathPortacath

PortacathsPortacaths

Inserted into internal jugular or subclavian Inserted into internal jugular or subclavian veins (occasionally femoral veins).veins (occasionally femoral veins).

Reservoir at end of catheter is buried Reservoir at end of catheter is buried subcutaneously.subcutaneously.

Reservoir is accessed with gripper needle.Reservoir is accessed with gripper needle. Tip of catheter lies in lower third of Tip of catheter lies in lower third of

superior vena cava.superior vena cava.

Portacaths (cont)Portacaths (cont)

Chest x-ray done post insertion to Chest x-ray done post insertion to confirm catheter tip position and confirm catheter tip position and exclude pneumothorax.exclude pneumothorax.

Used in patients who require life-long Used in patients who require life-long intravenous therapies.intravenous therapies.

Improves quality of life e.g. more Improves quality of life e.g. more discreet, can swim.discreet, can swim.