Vascular Access Patient Education 

A vascular access procedure involves the insertion or placement of a vascular access device (i.e., a sterile tube commonly referred to as a catheter) into a blood vessel allowing for access to the cardiovascular system via the vein.  The underlying ailment, disease, or medical need for access, along with the length of time a patient needs vascular access for treatment, the use of the vascular access such as the delivery of medication or fluids, and the patient medical history are all factors in determining which vascular access device is most clinically appropriate, and the procedure used to insert the such device.  A vascular access procedure ranges from a basic IV to a small or large bore central line via the Jugular or Femoral vein, and depending on the procedure, can be performed by nurses or doctors.  As it is an invasive procedure, a vascular access procedure requires a physician’s order and patient consent before being performed.

Patients who require ongoing therapy such as intravenous medications, including antibiotic treatments and other fluids, long-term nutritional support, hemodialysis, chemotherapy, or repeated blood draws can benefit from a vascular access procedure.

Peripheral IVs are used for the short-term administration or infusion of fluid or certain antibiotics that are appropriate for smaller veins.

Midlines are used when a patient needs therapy for longer than a few days or the patient has diminished lower arm access insertion sites. Midline catheters can last approximately four weeks and can supply patients with units of blood or certain types of antibiotics.  Midlines can reduce the number of patient sticks as a substitute for multiple PIVs that don’t last the course of treatment.

PICC lines are central lines that end in a large vein near the heart and can stay in a patient for up to 18 months. Patients who need vesicant (more acidic) therapy administration (certain antibiotics, TPN nutrition administration, or hemodynamic agents) for a longer period will generally receive a PICC line provided it is clinically appropriate. Since peripherally inserted, PICCs are generally a less expensive and benign central line option.

Small Bore Internal Jugular (IJ) and Femoral central lines provide vascular access benefits to patients with limited access to the chest or arm area. They are commonly placed in patients who have or likely to have Chronic Kidney Disease (e.g., dialysis patients), Upper Extremity DVTs (deep vein thrombosis), or Bilateral Mastectomy with lymph nodes removed, or who are DIVA’s (difficult IV access patients).  Small Bore central lines preserve upper arm veins should they be needed for other therapies in the future.

Large Bore lines, including Quad Lumens, are some of the largest diameter lines allowing for the most flow and can be used as Temporary Dialysis Catheters or Vas Caths. As Vas Caths, they enable dialysis therapy without having to have a fistula or graft placed.

The preparation is fairly straight-forward.  The vascular access clinician will review the doctor orders and your medical history to confirm the vascular access device, and then obtain your written consent for medical treatment.  The vascular access clinician will ensure a sterile environment, a comfortable position for both you and to obtain access to the insertion site, and the procedure will be done before you know it, generally about ten to sixty minutes long. 

After obtaining consent and confirming the doctor’s orders, the vascular access clinician will use their ultrasound to locate a viable vein.  Once located, the clinician will create a sterile environment, including vapor barrier, mask, gown, and gloves, scrub the area, apply a local anesthetic or numbing agent, and access the vein with a needle.  Using the needle, the clinician will thread a guidewire to hold the access and then remove the needle.  After the needle is removed, an introducer will be threaded over the guidewire.  The catheter will then be placed using the introducer applicable to the technique.  The line will be flushed, cleaned, and dressed, and the location confirmed via ECG or X-ray.

Risk of Infection – This is mitigated by maintaining sterility during the procedure and following best practices for care and maintenance.

Risk of Bleeding – This is mitigated through expert usage of the ultrasound to enable accurate vein and needle tip visualization.

Risk of DVT– This is mitigated through expert usage of the ultrasound to help ensure that the catheter to vein ratio allows for optimal blood flow around the catheter.

Your PICC line or Midline catheter does need care and attention to keep it clean and working.  This care includes changing the bandage (dressing), flushing the catheter with fluids, and changing the cap on the end of the catheter.  You must always wash your hands with soap and clean running water before and after touching any part of your catheter.  You must comply with all follow-up care instructions by your healthcare provider.  Sterile techniques must be used for dressing change, and if you or your family member, friend or anyone assisting you does not know sterile dressing techniques, you must contact your healthcare provider for instructions.  Dressing changes are as directed, which are usually about once per week; however, you must check the dressing daily and change it sooner if the dressing gets dislodged, wet, or soiled.  The catheter will be removed when it is no longer needed or indicated for use, if complications occur, or if it becomes infected.  In addition, you should avoid lifting anything heavier than 15 pounds and repetitive movements as that may dislodge the catheter.