Chapter 8: IV Therapy
8.3 Types of Venous Access
Critical Thinking Exercises: Questions, Answers, and Sources / References
- Differentiate different venous access devices: PVAD-short, midline catheter, peripherally inserted central catheter (PICC), percutaneous non hemodialysis central catheter, implanted venous access device (IVAD), and tunneled catheter. Provide one indication for each. Answer:
| Type of VAD | Characteristics |
| PVAD short | · PVAD-short sites are prone to phlebitis and infection in comparison to CVAD sites
· Easily monitored · can be inserted at the bedside. · CDC (2017) recommends that PVAD-shorts be replaced every 72 to 96 hours to prevent infection and phlebitis in adults. Other literature suggests that PVAD-short catheters be changed based on individual assessment of the site and not specific time frames (Gorski et al., 2012)
Indication: Used for infusions under six days and for solutions that are iso-osmotic or near iso-osmotic (CDC, 2017). |
| PVAD midline | · 5 to 20 cm long
· usually inserted into an antecubital fossa · catheter tip sits in the vein below the level of the axilla. · tip of the catheter sits in a vessel larger than a peripheral vein, it is significantly smaller than the superior vena cava (SVC). As such the types of drugs and solutions that can be safely administered through a midline catheter are the same as a PVAD-short (Rosenthal, 2007).
Indication: Used for IV therapy longer than a PVAD-short although the literature is inconsistent in terms of how long. The range is from 6 days to 8 weeks (RNAO, 2005 / 2008). |
| CVADs (generally speaking) | · Usually the tip of the catheter terminates in the superior vena cava just above the right atrium.
· Femorally inserted CVADs, the tip of the catheter should sit in the inferior vena cava. · Large vein = ability to deliver fluids and/or medications that can be overly irritating (high or low pH, high osmolality) to small peripheral veins long term IV therapy and / or high osmololity medications / solutions · ability to access multiple lumens and deliver multiple medications or solutions simultaneously even if they are incompatible with each other (Fraser Health Authority, 2014) · ability to deliver large volumes quickly · ability to maintain IV access over a prolonged period of time (Perry et al., 2018). · Some CVADs have technology associated with them that allows for monitoring of central venous pressure
Indication: long term IV therapy; IV therapy with high osmolality medications |
| CVAD – Peripherally inserted central catheter (PICC) | · tip is located in the SVC.
· inserted through the antecubital fossa or upper arm (basilic or cephalic vein) & threaded the full length until the tip reaches the SVC. · held in place with sutures or a manufactured securement device for as long as there is no evidence of complications.
Indication: long term IV therapy; IV therapy with high osmolality medications |
| Tunnelled central venous catheter
|
· long-term CVC ie. mont