Vascular Access

Why is vascular access necessary?

Patients with certain medical conditions require long-term intravenous access for administration of medications, chemotherapy, and/or nutritional supplements. Patients with kidney failure may require intravenous access for hemodialysis.

What is a vascular access catheter?

A vascular access catheter is a small, thin tube that is placed in a vein for long term medicinal therapy and/or for hemodialysis. For many patients undergoing long-term therapy, such as chemotherapy, it is uncomfortable to have an intravenous line placed every time they have chemotherapy. Additionally, over time, as the patients are subjected to numerous needle sticks, the veins in their arms become so scarred that the veins can no longer be used for therapy. Thus, a vascular access catheter may be placed in a vein for long-term therapy.

There are 2 types of vascular access catheters: temporary catheters (non-tunneled catheters) and tunneled catheters. Temporary catheters are used when intravenous therapy is needed for no longer than 2 weeks. These catheters are placed directly through the skin, usually just under the collar bone, and into the subclavian vein and superior vena cava, which is a large vein leading to the heart. In some cases, the catheter may placed in the arm and is then advanced to the superior vena cava. The hub of the catheter remains outside the body so that the physicians and nurses may administer medications. Some non-tunneled catheters include: Hohn catheters, peripherally inserted central catheters(PICC), and temporary dialysis catheters.

Tunneled catheters may be used repeatedly for up to 1 year. Tunneled catheters are also placed through the skin just under the collar bone and into the vein. However, because these catheters are placed for much longer use, part of the catheter is tunneled underneath the skin to minimize the risk of the catheter falling out over time. Like the non-tunneled catheters, the catheter hub remains outside of the body. Some tunneled catheters include: Groshong catheters, Hickman catheters, and tunneled dialysis catheters.

When should I get a vascular access catheter?

If your doctor has planned long-term intravenous medical therapy for you, which will require repeated intravenous lines, you should discuss with him the possibility of having a Hickman catheter insertion. A dialysis catheter is reserved for those situations in which a patient's hemodialysis fistula is not functioning. If the fistula cannot be opened through thrombolysis (a technique for dissolving blood clots that cause fistulae to become obstructed) or surgical intervention in a timely fashion, then the physician will request that a hemodialysis catheter be placed.

How is the procedure performed?

Several days prior to the procedure you will be given instructions from the Interventional Radiologist's office staff. You will need to have blood drawn at the hospital or a local clinic for testing. The staff will instruct you on how to prepare for the procedure including modification of your medications if necessary.

Before the procedure, a nurse will start an intravenous line in your arm to give you some medication to help you feel relaxed. You will be sleepy, but you will be awake throughout the procedure. The Interventional Radiologist will inject a local anesthetic in the chest area just beneath the collar bone. A small incision will be made through which the Interventional Radiologist will pass a small needle into the subclavian vein. Through the needle he will pass a small, thin wire called a guidewire into the superior vena cava which is a large vein in the chest.

The catheter is then advanced over the wire into the vein and the wire is removed. If a tunneled catheter is placed, the Interventional Radiologist will make a small tunnel underneath the skin of the chest, and then he will advance the catheter through the tunnel and into the vein. A small stitch will be made at each entry site. The nurse will make an appointment for you to return to the hospital 1 week after the procedure to have the stitches removed. After the procedure you will need to recover in the recovery room for one hour. After your discharge from the hospital, you should go home and rest for the remainder of the day. You may resume your normal activities the following day.

How do I care for my vascular access catheter?

For the first 7 days following the catheter insertion procedure, you should keep the catheter site clean and dry. You may sponge bathe around the catheter site. Clean the area with peroxide and apply betadine ointment and a bandage. After 7 days, you may shower, but you should continue to clean the insertion site with peroxide and apply a bandage to cover the catheter insertion site. "Tegederm" or a small square of plastic kitchen wrap applied over the catheter insertion site is advisable when bathing.

All vascular access catheters are prone to becoming obstructed if not flushed everyday. The obstruction is usually due to a small blood clot which has formed in the catheter lumen. To keep the catheter free from clot, it is recommended that the catheter be flushed once a day with a heparinized saline solution. Heparin is a medication used to prevent blood clots from forming. Because different catheters require different amounts of flush, your physician will instruct you in how much flush to use.