What are Vascular Access Procedures?
Vascular access procedure is a method where a thin, long tube called a catheter is inserted into a blood vessel in the arm, neck, legs, or below the collar bone to create an access point or pathway for patients who require intravenous (IV) access for a considerable length of time (longer than 7 to 10 days). The catheter is then threaded into a major vein that drains near the heart.
A simple intravenous line may be effective for short-term purposes but is not appropriate for long-term utility. When an intravenous line is required for a longer duration and/or safer venous access is required, a special catheter called a central venous catheter that is normally longer can be utilised. This catheter can stay in place either for a few days (temporarily) or for weeks to even years (long-term) so that it can be accessed easily and repeatedly over the required duration of the treatment without the need for repeat skin punctures.
Types of Vascular Access Procedures
Various types of vascular access devices are available. Your physician will choose the right one for you based on your condition, how long the catheter is required, what it is being used for, and your personal preference. The common types of vascular access catheters include:
- Central Venous Catheter: This is the standard central venous line with two openings (ports) that is placed directly into the internal jugular vein, in the base of the neck, or into the subclavian vein, just under the collarbone. This provides long-term central venous access for treatments that need high flow rates, such as plasmapheresis or dialysis.
- Peripherally Inserted Central Catheter (PICC): The PICC is a long catheter that is introduced through an arm vein, but its tip lies in a large central vein called the superior vena cava, a major vein that leads to the heart. It typically provides central IV access for several weeks to months or even longer, provided the catheter is working well and not infected. PICC lines are used for treatments such as total parenteral nutrition (TPN), antibiotics, chemotherapy, and also for drawing blood. They are also called midline catheters.
- Tunnelled Central Venous Catheter: This is referred to as a permanent catheter as it can last for up to 2 years, provided it does not get infected or blocked. The catheter is placed into the subclavian vein below the collarbone or into the jugular vein at the base of the neck. It comes out from a subcutaneous tunnel about 10cm from the entry point into the vein. This is the ideal solution for patients needing the catheter for more than three months. It is most often utilised for hemodialysis. The tunnel aids in holding the line in place as well as minimises the risk of line infection.
- Subcutaneous port (Porta-Cath): This is a permanent vascular access device comprising of a catheter that is connected to a small reservoir placed underneath the skin. The whole device is below the skin and is visible only as a small bulge where the reservoir is situated. The reservoir is covered with silicone, which is punctured with a needle when intravenous treatment is needed. The port is utilised mostly when IV access is required only intermittently over a long duration, as in patients who need chemotherapy.
Indications for Vascular Access Procedures
Your physician may recommend a vascular access procedure for a long-term intravenous line placement if you need:
- Long-term IV feeding for nutritional support
- Delivery of medications into your bloodstream for an extended period
- Administration of anti-cancer drugs or chemotherapy
- Intravenous antibiotic treatment
- Hemodialysis for kidney failure
- Blood transfusions
- Repeated blood draws for laboratory analysis
- You have difficulty maintaining or receiving a simple functional IV line
Preparation for Vascular Access Procedures
Preparation for vascular access procedure may involve the following steps:
- Blood tests to check for normal kidney function, to ensure your blood clots normally, and to obtain other information.
- You need to inform your physician if you have allergies to certain medications, anaesthesia, or contrast materials.
- You should also inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should not consume any solids or liquids at least 6 hours prior to the procedure.
- Arrange for someone to drive you home after the procedure as you may feel groggy due to the effects of anaesthesia.
- Written consent will be obtained from you after the procedure has been explained in detail.
What Happens During Vascular Access Procedures
Depending upon the site of the vascular access (such as arm, neck, or below the collarbone), your physician may carry out the procedure in a hospital room setting or in a catheterization lab so that your physician can use fluoroscopy (live X-ray imaging).
In general, the procedure involves the following steps:
- You will lie on your back on the table and the insertion area is cleaned with an antiseptic solution.
- A local anaesthetic is used to numb the area. Sedative medicine may also be used to help keep you comfortable and calm during the procedure.
- Once you are comfortable, your physician will use fluoroscopy or ultrasound to identify the vein for access.
- A small incision or a puncture is made in the vein and a guidewire is inserted into the vein.
- The catheter is then threaded into the vein over the guidewire and manipulated to its final position, normally in the superior vena cava, just above the heart.
- Depending on the type of vascular access being used, the catheter may be sutured into place or attached to a port (a small silicone and plastic device that sits underneath your skin).
- Your physician will then utilise stitches or glue to close the small surgical cut or the puncture hole.
- An additional X-ray may also be ordered to ensure that the catheter is placed in the correct position.
Post-Procedure Care and Recovery
Following the procedure, you may experience pain, swelling, and bruising from the area of the incision for which your physician will prescribe appropriate medications. These symptoms should resolve over the next 1 week. You may go home the same day after a few hours of observation in the medical facility. You are advised to take ample rest for the remainder of the day. You may resume work and your normal daily activities the following day but should refrain from strenuous activities or lifting heavy objects for at least a couple of weeks. You need to call your physician if you notice a fever or other signs of infection such as tenderness, bleeding, and redness at the catheter insertion site.
Risks and Complications
Vascular access procedures are relatively safe; however, as with any procedure, some risks and complications may occur, such as:
- Arterial puncture
- Air embolism
- Abnormal heart rhythm
- Bruising and soreness
- Wound infection
- Catheter fracture
- Accidental catheter dislodgement
- Catheter occlusion (blockage)
- Vein occlusion