Common Types and Uses of Venous Access Devices
NB: “In order to preserve veins for future hemodialysis access (fistula or graft), it is essential to consult with the nephrologist before placing upper extremity or subclavian lines of any type in patients who might eventually require dialysis.”
| Type of Line | Indications / When to Use | Contraindications / When to avoid | Comments |
| Peripheral Lines | |||
| Peripheral IV (PIV) | For short-term use (up to 72-96 hours) i.e. 3-4 days. | Don’t use when IV access is needed for more than a few days. | In order to reduce the possibility of phlebitis, the CDC recommends replacing peripheral venous catheters and rotating the site at least every 72 to 96 hours. In our current hospital, nurses must change the IV site every 3 days. |
| Midline | For venous access of 1 to 4 weeks’ duration. | Dont use when IV access is needed for longer than 1 month or when vesicant medications are involved. | |
| Central Lines The PICC line is peripherally inserted. There are 3 main types of centrally inserted catheters: non-tunneled, skin-tunneled, and implantable ports. |
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| PICC (Peripherally inserted central catheter) |
For medium-term venous access (up to 6 months). Common indications for PICC lines include antibiotics, TPN, analgesics, chemotherapy, transfusions, and frequent blood sampling. | Don’t use when a long-term (or permanent) access is required. It’s also not recommended for dialysis (or predialysis) patients | PICC lines require frequent flushing and dressing changes, and the insertion site should not get wet. Complications include dislodgment, occlusion, mechanical phlebitis, and DVT. The claim that PICCs have lower rates of infection than centrally inserted catheters has not yet been substantiated in the literature. |
| Non-tunnelled central catheter | For short-term access when PIV is not suitable, and especially for resuscitation and central venous pressure monitoring. The lifespan of the catheter is 5 to 7 days, and can provide up to 5 lumens for separate access. |
Don’t use when access is required for more than a few days (use a tunneled catheter instead). These catheters are associated with a higher risk of infection and are inappropriate for patients who require central venous access for longer than 2 weeks |
Preferred veins include the internal jugular (IJ) and external jugular. The subclavian vein is easy to use but is not advisable because of the relatively high incidence of venous thrombosis and the increased risk of catheter damage or fracture associated with subclavian lines. |
| Tunnelled Central Catheter | For frequent long-term access, and especially for TPN, transfusions, and frequent blood sampling Can be used when PICC line is contraindicated or not possible | Don’t use it when access of shorter duration is required (consider an implantable port if access is to be less frequent) | |
| Implantable port | For infrequent access on a long-term basis or when lifestyle concerns make one of the other options less appealing | Don’t use it when venous access is regularly required (frequent needle pokes would be uncomfortable for the patient) | |
This table is modified from Can Fam Physician. 2009 May; 55(5): 494–496.
In one study, Using midline catheters in place of central lines decrease the rate of central line-associated bloodstream infection (CLABSI) in a ventilator unit. In addition, no bloodstream infections were associated with midline catheters. Infect Dis Clin Pract (Baltim Md). 2015 May
“Mechanical phlebitis is caused by irritation of the venous endothelium by the catheter.This is more prevalent with PICCs inserted in the antecubital fossa than in the upper arm. Small veins at the point of insertion, as well as catheter movement when bending and straightening the arm, are the main causes of mechanical phlebitis.” Medscape
References
Can Fam Physician. 2009 May; 55(5): 494–496. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682308/
Infect Dis Clin Pract (Baltim Md). 2015 May; 23(3): 131–134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420154/
https://www.medscape.com/viewarticle/508939_6