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 Venous Access

What is venous access?

Venous access allows your physician to deliver medicine directly into your bloodstream without repeatedly puncturing your blood vessels. In venous access, a long, thin tube, called a catheter, acts as a kind of entry way into your vein. One end of the catheter is placed in a vein, usually in your arm, neck, or chest. The other end exits your body so that your physician can deliver your medicine into your vein by means of the catheter. Sometimes this delivery end may be connected to a circular device called a port under the surface of your skin.

Physicians often use needles to inject medicine into your bloodstream. This way, the medicine is carried by your bloodstream and quickly reaches the areas where your body needs it. However, with repeated punctures, the needles can damage your veins over time. If you have weak or thin veins, you may not be able to receive many needle injections. Strong medicines can also scar your veins.

If you need regular injections of medicine over a long period of time, venous access can protect your veins. For example, some cancer patients receive venous access devices to receive chemotherapy drugs. Physicians also use venous access devices to supply fluids, draw blood, and give blood transfusions. Another type of venous access is called dialysis access. Dialysis access devices help patients who have kidney problems receive hemodialysis to filter their blood as their kidneys would normally filter it if they were healthy.

One common type of venous access is an intravenous (IV) line. An IV line is placed inside a vein, often in your hand or arm, and stays in place for a relatively short period of time. Other venous access devices are designed to go deeper in your body and stay inside your body longer. For example, the catheters in some venous access devices reach from an arm vein into a larger vein near your heart where the blood flow is much more rapid.

Some venous access devices are made of special, soft materials that are less irritating to your veins and are designed to safely remain in your body for weeks or months, if necessary.

How do I prepare?

Your physician may order tests before placing a venous access device. These tests help your physician determine whether your veins are healthy and include:

  • Chest x ray
  • Duplex ultrasound
  • Venography, which takes x ray pictures of your veins while a contrast fluid, visible on x ray, is injected
  • Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to take pictures of your veins

Your physician or vascular surgeon will advise you of the best procedure for your particular situation and will give you the instructions you need to follow before the procedure. Usually, you will not have to do any special preparation before venous access.

When am I a candidate for venous access?

You may need venous access if you have a condition that requires prolonged access to your venous system and your veins are weak, scarred, or thin. People with cancer, for example, often need venous access because chemotherapy drugs can irritate arm veins. People who need weeks of antibiotic treatment for a severe infection may also require venous access.

Your physician or vascular surgeon will decide which type of venous access device you will need. He or she will consider how long you will need the device, what types of drugs will be used, how often you will receive drug injections, and how healthy you are overall. Based on these factors, you may require different types of venous access devices, from an IV to a device that is inserted into your large chest or neck veins and stays under your skin permanently.

Am I at risk for complications during venous access?

The most common complication from venous access is infection. You have a greater chance of infection if you have abnormally low white blood cell counts or are receiving chemotherapy or bone marrow transplants.

If you have problems with blood clotting or with the veins in your legs, you may have an increased risk of blood clots in your venous access device.

What happens during venous access?

Your physician or vascular surgeon can choose one of four general types of venous access devices. These types are:

  • Short-term peripheral catheters, such as IVs
  • Peripherally inserted central catheters, or PICCs, which are inserted in your arm but are much longer than IVs and can be left in place for more extended periods
  • Tunneled catheters, which are placed directly into a large vein in the center of your body (called your vena cava) through a tunnel in your chest and can be left in place for several months
  • Subcutaneous vascular access devices, or SVADs, which are small, round devices that are inserted under the skin of your chest and can be left in place indefinitely

Your physician or vascular surgeon will follow different steps to insert your venous access device. These steps will depend on the device he or she chooses and where it will be inserted in your body. However, most venous access procedures consist of four basic steps. Your physician or vascular surgeon will puncture your vein, insert a catheter into your vein, place the tip of the catheter in your vein or in your vena cava, and close the point where the catheter exits your body. Most procedures require 30 to 45 minutes to complete.

If you are receiving an IV or PICC line, a nurse or physician may numb your skin before inserting the catheter. You do not have any nerve endings inside your veins, so you will not feel the catheter as it moves through your arm and chest. You might feel a slight pressure or a mild tugging sensation when your nurse or physician inserts the catheter.

If your physician is inserting a tunneled catheter or an SVAD, you may need local anesthesia and possibly a sedative. The SVAD procedure requires minor surgery. Your vascular surgeon will create a pocket in your chest. He or she will then place a small circular device called a port in this pocket, and then he or she will close your skin over the port. Your port will connect to a catheter in your vena cava.

What can I expect after venous access?

Usually, you will spend about 1 hour in the recovery room. Since you may have had some sedation, you should arrange for a ride home, and you usually can resume normal activities the next day. It is usually advisable to keep your incisions and exit sites clean and dry for the first week. Your physician may recommend sponge bathing around the area and applying antibiotic ointment. If you have had stitches, your physician will remove them in about 7 to 10 days.

Are there any complications?

Most complications are minor and can include bleeding, bruising, or swelling where your physician or vascular surgeon inserted the catheter. Sometimes, the stitches might feel tight. These complications usually go away in a few days.

In the days after your procedure, the catheter tip inside your vena cava may move slightly because you have moved your arm or torso. Sometimes the catheter can twist or kink and may not work properly, or it may disconnect from your port. Your physician can usually manage these problems easily.

Rarely, serious complications can occur. These could include an air bubble in your vein, a blood clot in a vein in your lungs, blood or air that collects in the membrane around your lungs, abnormal heart rhythms, or a puncture in a major vein or artery, your heart, or your lungs.

Sometimes, after your venous access device has been in place for a period of time, infection can occur. The most serious type of infection is sepsis, or blood infection. Other types of infections include vein infections and skin infections. Some infections require removal of the device to clear them up.

Contact your physician right away if your venous access device no longer works or you experience any of the following symptoms:

  • Fever
  • Swollen arms or legs
  • Shortness of breath
  • Mental changes, like difficulty concentrating
  • Bleeding or oozing from any incision point or catheter exit site
  • Red or tender skin

What can I do to stay healthy?

If you take care of your incisions and your catheters, you can lower your risk of infections and blood clots. Your physician will show you how to flush your catheters with a salt solution, an anti-clotting drug called heparin, or both. You will need to flush your access device after each use. You may also need to flush your device daily even if you don't use it, although some catheters may be flushed less frequently.

You will need to keep the skin around your catheter as clean as possible, including trimming hair in the area. You will also need to change the bandages every 1 to 3 days and any time they become wet or soiled. When you replace them, make sure that your skin is dry. Your physician may allow you to shower or bathe, but you should avoid swimming because of the risk of contaminating the device.

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Revised September 4, 2009

 

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VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.