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 normally last for a few 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 do not last the course of treatment.

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PICC lines are central lines that end in a large vein near the heart and are considered long term devices. Patients who need therapy that is irritating to the veins, such as certain antibiotics, TPN administration or Chemotherapy for a longer period of time often will often receive a PICC line provided it is clinically appropriate.

Small Bore Central Lines provide vascular access benefits to a wide variety of patient populations. They are commonly placed in patients who need arm vein preservation, such as Kidney Disease patients, or when the placement of a peripheral device, such as a PICC line, could be harmful to the patient. These patients could include Mastectomy patients with lymphnodes removed, patients with arm injuries or infections, or those with vascular disease. In most situations, for patients needing central access, a small bore central line is the safest option.

Large Bore lines are large diameter central lines allowing for maximum fluid and blood flow and include Temporary Dialysis Catheters, often called Vas Caths. For patients needing urgent dialysis, Vas Caths are often placed at the bedside. Large Bore lines are often used for rapid fluid resuscitation in certain emergencies.

The preparation is fairly straight-forward.  The vascular access clinician will review the doctor’s order and your medical history to confirm the vascular access device, and then obtain your written consent for medical treatment.  The vascular access clinician will create a sterile environment, ensuring your comfort during the procedure. A great majority of the procedures will be completed in less than 30 minutes, time frame often depends on your vasculature with some procedures taking slightly longer.    

After obtaining consent and confirming the doctor’s orders, the vascular access clinician will utilize ultrasound to locate the best insertion site. Once located, the clinician will clean your skin with an antiseptic, create a sterile barrier for the insertion, give a generous amount of numbing medicine for your comfort, and then access your vein with the needle. You will likely not feel this needle insertion. After access to the vein is obtained, a guidewire and introducer will be utilized to place your catheter. 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.