Vascular Access and Port Placement

Definition:
A central venous catheter is a tube that is inserted beneath your skin so there is a simple, and sometimes pain-free way for doctors or nurses to draw your blood or give you medication and nutrients. When you have a central venous catheter, you are spared the irritation and discomfort of repeated needlesticks. There are several types of devices, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters called PICC lines, dialysis catheters and implantable ports.

Indications/Risks/Benefits:
Your doctor may suggest placement of a venous catheter for medication infusion such as chemotherapy or antibiotics, dialysis access, hyperalimentation, or if frequent blood tests are needed in the case of chronic disease processes.

These procedures are safe with little to no risk for the patient. Infrequently there can be mild bleeding at the catheter entrance site. Infection rate is less than 1%.

The benefits of these devices are fast, easy access to the venous system for treatment. The need for repeated needle sticks is removed or vastly decreased depending on the type of catheter placed.

How we do the procedure:
The patient is placed on the xray table and the neck and/or arm are cleaned and sterile drapes are placed. For PICC lines the arm veins are used to place the catheter. All other catheters enter through the internal jugular vein in the neck and are tunneled under the skin to the desired site on the skin, usually the upper chest. The region of interest is anesthetized with a local injection. A needle is placed into the vein under ultrasound and a wire is placed. The catheter is tunneled under the skin if necessary and inserted over the wire into the vein. If good blood flow and injectability is noted the catheter is sutured in place. Any exposed ends of the catheter are covered with gauze. For Ports, no exposed portions are present and the incisions are covered with gauze.

Pre test directions:
There are no specific preoperative instructions. If sedation is planned the patient must not eat after midnight the night before. Sedation is not commonly needed however for these minor procedures.

Post Care:
The patient may experience mild pain at the access site usually controlled with Tylenol. Stronger medications will be prescribed if needed especially for Ports. Patients can return to normal activity the next day but must be mindful of the catheters if any portions extend from the skin. Keep the catheter ends covered and taped securely to the skin. The catheters should be kept clean and dry.