Indwelling Access Devices

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Chapter 41 Indwelling Access Devices

Franklin W. Huang, Janet L. Abrahm

Figure 41-1 Schematic diagram of an indwelling central venous catheter in place. Insertion site refers to the insertion of the proximal end of the catheter into the chest wall. Clamp attached to the catheter is shown next to the Luer-Lok cap at the distal end.

(Modified from Hickman Subcutaneous Port, Use, and Maintenance and How to Care for Your Hickman or Broviac Catheter. Cranston, RI, Davol Inc.)

Figure 41-2 Totally implanted Hickman subcutaneous (central venous access) port with a noncoring needle in place.

(Modified from Hickman Subcutaneous Port, Use, and Maintenance and How to Care for Your Hickman or Broviac Catheter. Cranston, RI, Davol Inc.)

Table 41-1 Choices of Indwelling Venous Access Devices

Choice of Device

We recommend indwelling venous access devices based on patient characteristics and preference, anticipated duration of use, purpose(s) for which the device is required, and relative complication rates among catheters and ports.

PICCs can be selected when duration of use will be 3 months or less. They are an appropriate choice when patients have chest wall problems, require outpatient-based treatments, and/or have thrombocytopenia. PICCs allow for vesicant infusions, antifungal and antibiotic therapies, and hyperalimentation.

Peripheral ports may be used longer than PICCs, but not longer than 6 months, and they may be chosen for patients with chest wall problems receiving outpatient-based treatments.

Tunneled catheters may be chosen for patients with thrombocytopenia who require frequent access, rapid infusion, or administration of vesicants. Valved catheters that do not require heparin are useful for patients who should not receive heparin. Like peripheral ports, they may be used for up to 6 months.

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