Vascular access tubes
Vascular access tubes, also known as catheters, are medical devices inserted into veins, typically in the arm, neck, or beneath the collarbone, to provide long-term intravenous access. They are essential for patients requiring prolonged treatments such as chemotherapy, pain management, nutritional support, or antibiotics. Common types of vascular access tubes include peripherally inserted central catheters (PICC), Hickman, Broviac, Groshong catheters, and subcutaneous ports.
The placement of these tubes can occur at the bedside, in an operating room, or in vascular radiology, using sterile techniques to minimize complications. Post-procedure, verification via chest X-ray ensures proper placement before the line is utilized for therapies or lab tests. Patients or caregivers are typically entrusted with ongoing home care, including flushing the access and changing dressings to maintain functionality.
While vascular access tubes have greatly advanced with the introduction of new technologies and materials, potential risks, such as pneumothorax, bleeding, and infection, must be considered. Overall, these devices play a crucial role in facilitating reliable venous access for patients with various medical needs.
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Vascular access tubes
ALSO KNOWN AS: Peripherally inserted central catheters (PICC), subcutaneous ports, Hickman catheters, Groshong catheters, Broviac catheters
DEFINITION: A vascular access tube is a catheter inserted into the veins of the arm, neck, or just beneath the collarbone for long-term intravenous access (greater than seven to ten days). The catheter can also be used to draw blood for lab tests. Patients receiving long-term chemotherapy, pain medications, nutrition, or antibiotics will have vascular access.
Cancers treated: All requiring long-term therapy
Why performed: Many patients have poor veins or are unable to receive treatment without access.
Patient preparation: Vascular access lines can be placed at the bedside, in the operating room (OR), or vascular radiology. Procedures at the bedside require no pre-procedure preparation. Patients going to the OR or vascular radiology are not allowed to eat or drink for at least eight hours before line placement due to the anesthesia.
Steps of the procedure: All lines are placed using a sterile technique. For peripherally inserted central catheters (PICC), a catheter is inserted through the antecube to be threaded up the arm and to end in the superior vena cava. PICC lines are flushed at least once a day, and their dressings are changed once a week.
For ports, a small titanium or plastic reservoir is inserted and stitched into place in the upper chest. The catheter is attached to the reservoir, inserted into the vein, and then threaded into the superior vena cava. The reservoir is accessed through the patient’s chest wall with special needles. To prevent clotting, ports must have a needle inserted and flushed at least once a month. This line can be placed in the OR or vascular radiology.
Hickman, Broviac, or Groshong catheters are also placed in the upper chest wall. The line is inserted through a small into the vein and follows until the end rests in the superior vena cava. It is held into place by a small cuff located under the skin; typically, stitches are not used. The patient or caregiver will be responsible for flushing the access and changing the dressing every seven days.
Vascular access tubes have advanced in the twenty-first century. Technological advances have introduced endovascular devices that create arteriovenous fistulas, allowing for a better connection between arteries and veins and reducing the need for surgery. New materials for vascular tubes were also introduced. Further, doctors began using ultrasound to guide needles directly into veins. These advances have benefited patients with chronic kidney disease, although they have increased the safety and effectiveness of vascular access tubes for all patients.
After the procedure: Line placement is verified by a chest X-ray. Once the line has been verified, it can be used to infuse therapy or for lab sampling. The patient or caregiver is responsible for home care, including flushing the access and changing the dressing.
Risks: The risks associated with vascular access lines are pneumothorax (collapsed lung), bleeding, and infection.
Results: This procedure results in reliable venous access to receive therapy and blood draws.
Bibliography
Alpenberg, Sara, et al. "Feeling Confident in Using PICC Lines." Home Health Care Management & Practice, 2015, doi.org/10.1177/1084822314566300. Accessed 17 June 2024.
Kaplan, Jennifer, Matthew F. Niedner, and Richard J. Brilli. "Central Venous Vascular Access." Pediatric Critical Care Medicine. London: Springer, 2014, pp. 345–70.
Lawson, Jeffrey H., et al. "Challenges and Novel Therapies for Vascular Access in Haemodialysis." Nature Reviews. Nephrology, vol. 16, no. 10, 2020, p. 586, doi.org/10.1038/s41581-020-0333-2. Accessed 17 June 2024.
Paulson, William D., Louise Moist, and Charmaine E. Lok. "Vascular Access Surveillance: An Ongoing Controversy." Kidney International, vol. 81.2, 2012, pp. 132–42.
“Vascular Access Procedures.” Radiologyinfo.org, www.radiologyinfo.org/en/info/vasc‗access. Accessed 17 June 2024.
“Vascular Access Devices: PICCs and Ports.” Cystic Fibrosis Foundation, www.cff.org/managing-cf/vascular-access-devices-piccs-and-ports. Accessed 17 June 2024.