Vascular access is the process of using techniques to access veins in a patient. This is typically done to administer fluids and medications. There are various types of vascular access procedures that may be done depending on the situation.
Peripherally inserted central catheter (PICC) lines involve using a thin tube (catheter) inserted into the major vein leading to the heart called the subclavian vein, but the brachiocephalic vein may also be used. The process of inserting the catheter is done with imaging guidance since these veins lie deep within the chest or arm. Once the catheter is inserted a port is placed on the outside of the skin to provide continuous access to the catheter. A PICC line can be used for several reasons. Some people undergoing chemotherapy may have a PICC line because it is much easier than finding a vein for frequent chemo sessions. If a person needs nutrition supplementation, it can also be inserted into the PICC line. Central lines are another type of PICC line.
Peripheral intravenous catheters (PIVC) are what you think of when you have a traditional IV. Most PIVCs are set up in the fold of the arm, but they may be inserted in any number of places depending on access. A PIVC is typically used in hospital or outpatient facilities once the person enters the emergency room or is taken to their room for a scheduled procedure. PIVCs are used to start a bag of normal saline. The flow of normal saline helps keep the line open and provides the patient with fluids when needed.
The line has other functions. Medications can be administered through the line. Depending on the situation, some common medications that may be administered include medications to reduce anxiety, pain medicine, anticoagulants, or those to initiate anesthesia. Most healthcare providers are capable of placing a PIVC, such as medical assistants and nurses. In rare instances, someone with more experience may be needed for people who have veins that are difficult to access. Splinting of the body part where the PIVC is placed might be necessary if the areas flex easily, such as the hands or feet. This is used to keep the PIVC stable so it does not come out of the vein.
Femoral vein cannulation (FVC) is another type of vascular access that is used in special situations. The femoral vein is located in the groin area. Due to the location of this vein, it is more challenging to place the cannula, and there is an increased chance of infection. FVC is typically used when less invasive placement of lines cannot be done or there is an emergency situation, such as someone in cardiac arrest since this vein is larger and more reliable. After the area is cleaned and anesthetized with lidocaine, imaging may be used to find the vein, or the vein may be found by palpating the patient and identifying anatomical landmarks. Although there are several techniques to place the cannula, a large-gauge needle is inserted into the groin area and into the vein. A guidewire is also inserted, eventually leaving the cannula in place. The cannula is secured with sutures to prevent shifting.
There are several venous access methods used depending on the needs of the patient and the urgency of the situation. More invasive forms of venous access may be used in patients with veins that are difficult to palpate or too small for simple access methods.
For more information, visit a mobile vascular access service near you.