This document discusses various types of venous access devices, including their indications, considerations, and characteristics. Short-term peripheral IV catheters are indicated for infusion of non-vesicant drugs, fluids, and blood products. PICCs are ideal for mid- to long-term therapy and can stay in place for the duration of therapy. Midlines can be used for a longer period than conventional peripheral catheters but shorter than PICCs, terminating below the axillary vein. Non-tunnelled central venous catheters are used for short-term access and infusion of vesicant medications or fluids. Implantable ports are typically indicated for extended IV therapy and preferred by patients concerned about body image. Tunnel

1. Venous Access devices
Indications & considerations

2. Short term peripheral IV catheters
• Indicated for short term venous
access for infusion of non-vesicant
drugs, fluids and blood products
• Commonly made of polyurethane
and less commonly these days,
made of Teflon
• Varieties of design include; ported
(eg. BD Venflon Pro), non-ported
(eg. BBraun Introcan), and
integrated (eg. BD Nexiva)
• Available typically in a range of
sizes (14 – 26g and lengths

3. PICC Lines
• PICCs are ideal for patients who require mid
to long term therapy and can stay in place
for the duration of therapy.
• PICCs are usually manufactured from silicone
or polyurethane, and measure approximately
50 – 60cms in length.
• PICC placement is obtained through the
veins in the upper arm, usually the basilic,
cephalic or brachial vein with the tip ideally
placed in the lower SVC or proximal right
atrium.
• The basilic vein offers optimal access due to
the fact that it has the greatest blood flow,
largest diameter and offers the straightest
route to the superior vena cava

4. Midlines
• Midlines are non - tunnelled peripheral VADs which
are inserted through a peripheral vein in the arm
(basilic, brachial or cephalic vein).
• Midlines can be used for a longer period of time than
conventional peripheral catheters but typically,
although not always, a shorter duration than a PICC
line.
• They are usually 7.5 to 25cms long and the tip is not
terminated centrally in the SVC. I
• Typically terminates at the axillary vein or below.
• A follow-up chest X-ray is not required to confirm
catheter placement although this might be useful for
difficult insertions.
• Midlines do not enter the central system and
therefore have the same limitations as peripheral
cannula. Drugs with a pH below 5 or greater than 9
should be avoided or administered with caution (INS,
2016)

5. Non-tunnelled Central Venous Catheters
• Commonly used for short term access in
critical care areas and emergency
departments for infusion of vesicant
medications, rapid infusion of bloods and
intravenous fluids
• Also indicated for patients requiring
intermittent or continuous CVP
monitoring
• Usually inserted into the internal jugular or
subclavian vein, with the catheter tip
resting in the superior vena cava just
above the right atrium.
• Available in a range of sizes, lengths and
lumen configurations

6. Implantable Ports
(Portacath)
• Typically indicated for use in patients requiring
IV therapy over an extended period of time
• Often preferred by patients concerned about
body image and lifestyle implications of long
term therapy
• A thin, soft, hollow tube made of plastic
put into a vein in the chest or arm with an
opening (the Port) just under the skin.
• The port is a disc about 2.5–4cm (1–1.5in) in
diameter.
• The tube is usually put in (tunnelled) under the
skin of the chest or in the arm.
• The tip of the catheter sits in the SVC

7. Tunnelled catheters
• Indicated or medium to long-term delivery IV
medications, and fluids
• Made from soft, flexible materials including silicone
or polyurethane.
• Inserted via the large veins of the neck or chest
using a guide wire and it is tunnelled
subcutaneously until it exits on the chest wall.
• Commonly equipped with a fibrous (Dacron) cuff,
which sits in the skin tunnel. The patient's tissue
then bonds with the line to create a secure fix and
will act as a mechanical barrier to prevent infection
travelling along the line.
• The distal tip should rest in the lower third of the
superior vena cava. They are usually sutured in
place for a minimum of 21 days until the bonding
process is complete. These lines may be
openended (Hickman®) or valved (Groshong®)
and are available in single, dual or triple lumen.

8. Extended dwell peripheral IV catheters
• A relatively new innovation in
intravenous access
• Indicated for patients that have
limited venous access and where vein
preservation is a primary
consideration
• Typically these devices are short
midlines (4-8cm) that are placed as
an alternative to multiple PIVCs in
patients requiring intravenous
medications or fluids for more than a
week
• Commonly sited either above the ACF
or in the forearm, with or without the
use of ultrasound

9. Discussion….