Peripheral IntraVenous Catheter (PIVC)

 

What it is

  • A short (< 7.5 cm), hollow, plastic tube inserted into a peripheral vein, usually in the hand or arm. Ultrasound guided insertion is recommended when no visible or palpable veins are present, for small children and people with fragile or compromised veins.

What it is used for

  • Short-term (< 7 days) delivery of intravenous fluids and medications

Complications

  • Pain, tenderness, inflammation of the vein, blockage, thrombus (blood clot), dislodgement, possible infection, infiltration and extravasation injury

How to prevent complications

  • Use skilled inserters
  • Preferred insertion site is the forearm, unless for a brief procedure
  • Avoid insertion in areas of high flexion (wrist, elbow)
  • Choose smaller catheter sizes to reduce vein irritation (use 20G or smaller in adults)
  • Provide pain relief: local anaesthetic/vapocoolant spray before insertion
  • Prepare skin with chlorhexidine and alcohol and allow to dry before insertion
  • Use needlefree access device to close catheter to the atmosphere
  • Perform hand hygiene before touching the device
  • Use aseptic non-touch technique to limit risk of infection
  • Ensure dressing remains clean, dry and intact
  • Use 1-2 drops of skin glue, a securement device and dressing to anchor the PIVC
  • Scrub the catheter hub with antiseptic and allow to dry before accessing the PIVC
  • Assess each shift for complications or more frequently as per hospital guidelines
  • Remove if complications occur and as soon as no longer needed
 

Peripherally Inserted Central Catheter (PICC)

 

What it is

  • A long (> 45 cm in adults), hollow, plastic tube inserted via a peripheral vein in the upper arm and advanced into the superior vena cava (the large vein feeding directly into the heart). The PICC tip sits just outside the heart. Ultrasound guided insertion is strongly recommended.

What it is used for

  • Medium-long term (> 2 weeks; can remain for several months) delivery of intravenous fluids, medications, nutrition or chemotherapy, and sometimes blood sampling

Complications

  • Pain, tenderness, inflammation of the vein, blockage, thrombus (blood clot), partial or complete dislodgement, internal malposition, infection

How to prevent complications

  • Insertion of a PICC must be done using full barrier precautions (sterile gloves, sterile gown, sterile drapes, face mask) by a skilled inserter
  • Choose a catheter size <45% the vein to avoid thrombosis
  • Choose a single lumen to reduce infection risk
  • Prep skin with chlorhexidine and alcohol and allow to dry before insertion
  • Use needlefree access device to close catheter to the atmosphere
  • Perform hand hygiene before touching the device
  • Use aseptic non-touch technique to limit risk of infection
  • Replace dressing if not clean, dry and intact, and routinely at 7days.
  • Use a securement device and dressing to anchor the PICC
  • Scrub the catheter hub with chlorhexidine and alcohol and allow to dry before accessing the PICC
  • Assess site daily for complications when not in use and during each administration
  • Flush line with normal saline after intermittent use
  • Remove if complications occur or when no longer needed
 

Non-tunnelled Central Venous Catheter (nt-CVC)

 

What it is

  • A hollow, plastic tube, ranging from 4cm in paediatrics up to 25cm in adults, inserted via a vein in the neck (typically internal jugular), chest (subclavian), or groin (femoral) into a large central vein. Ultrasound guided insertion is strongly recommended.

What it is used for

  • A hollow, plastic tube, ranging from 4cm in paediatrics up to 25cm in adults, inserted via a vein in the neck (typically internal jugular), chest (subclavian), or groin (femoral) into a large central vein. Ultrasound guided insertion is strongly recommended.

Complications

  • Pneumothorax (lung puncture), blockage, thrombus (blood clot), partial or complete dislodgement, internal malposition, bleeding, infection, air embolus

How to prevent complications

  • Insertion of a nt-CVC must be done using full barrier precautions (sterile gloves, sterile gown, sterile drapes, face mask). Ultrasound guided insertion is recommended by a skilled inserter.
  • Choose the least number of lumens to reduce infection risk
  • Choose antimicrobial nt-CVC if infection risk is high
  • Prep skin with chlorhexidine and alcohol and allow to dry before insertion
  • Perform hand hygiene before touching the device
  • Use needlefree access device to close catheter to the atmosphere
  • Use aseptic non-touch technique to limit risk of infection
  • Replace dressing if not clean, dry and intact, and routinely at 7days.
  • Choose a chlorhexidine disc/dressing to prevent infection
  • Use a securement device or dressing to anchor the nt-CVC
  • Scrub the catheter hub with chlorhexidine and alcohol and allow to dry before accessing the nt-CVC
  • Assess site daily for complications
  • Flush line with normal saline after intermittent use
  • Remove if complications occur and as soon as no longer needed
 

Tunnelled Central Venous Catheter (t-CVC)

 

What it is

  • A long (15-25 cm in adults), hollow, plastic tube inserted into a large central vein in the neck (internal jugular vein) or chest (subclavian vein or brachiocephalic vein).

What it is used for

  • Long term (> 3 months) delivery of intravenous fluids, medications, nutrition or chemotherapy, and sometimes blood sampling

Complications

  • Pneumothorax (lung puncture), blockage, thrombus (blood clot), partial or complete dislodgement, internal malposition, bleeding, infection, air embolus

How to prevent complications

  • Insertion of a t-CVC must be done under sterile conditions by a skilled inserter
  • Prep skin with chlorhexidine and alcohol and allow to dry before insertion
  • Perform handwashing before touching the device
  • Use needlefree access device to close catheter to the atmosphere
  • Use aseptic non-touch technique to limit risk of infection
  • Ensure dressing remains clean, dry and intact
  • Use a securement device or dressing to anchor the t-CVC
  • Scrub the catheter hub with chlorhexidine and alcohol and allow to dry before accessing the t-CVC
  • Flush line with normal saline after intermittent use
  • Assess site daily for complications
  • Remove if complications occur or when no longer needed
 

Totally implanted venous port device

 

What it is

  • A small medical device surgically implanted under the skin in the subcutaneous tissue of the chest and connected by a catheter to a deep central vein in the chest

What it is used for

  • Long term (months to years) delivery of intravenous fluids, medications, blood products, nutrition or chemotherapy, and sometimes blood sampling

Complications

  • Pneumothorax (lung puncture), blockage, thrombus (blood clot), partial or complete dislodgement, internal malposition, bleeding, infection, air embolus

How to prevent complications

  • Insertion of a totally implanted venous port device must be done in the operating room under sterile conditions
  • Perform handwashing before accessing the device
  • Prep skin with chlorhexidine and alcohol and allow to dry before inserting a special port needle into the port
  • Use aseptic non-touch technique to limit risk of infection
  • Assess site daily for complications
  • Flush line with normal saline and lock with heparin after use and at least every 4-6 weeks depending on hospital policy.
 

 

Contact UsDonate NowTell a FriendBookmark SitePrint