Chapter 17: Vascular access devices: insertion and management
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Definition
A vascular access device (VAD) is a device that is inserted into either a vein or an artery, via the peripheral or central vessels, to provide for either diagnostic (blood sampling or central venous pressure reading) or therapeutic (administration of medications, fluids and/or blood products) purposes (pressure is measured in mmHg or pounds per square inch (psi)). There is now a comprehensive range of VADs available, which allows selection to be made based on the device, the required therapy and the quality‐of‐life needs of the patient (RCN [381]). Table 17.1 lists the main types of VAD.
Table 17.1 Vascular access devices
| Type of device | Possible materials | Features | Common insertion site (veins) | Recommended indwelling life and common uses |
|---|---|---|---|---|
| Peripheral intravenous cannula (PIVC) |
Teflon (PTFE)
Polyurethane
Vialon |
Winged or non‐winged
Ported or non‐ported
Closed system, single ported or dual ported |
Cephalic or basilic
Dorsal venous network | Removed when clinically indicated for short‐term access |
| Midline catheter |
Silicone
Polyurethane |
Single lumen
Dual lumen |
Basilic
Median cubital Cephalic | Used for 1–6 weeks for short‐ to intermediate‐term access |
| Peripherally inserted central catheter (PICC) |
Polyurethane
Silicone |
Triple lumen
Dual lumen
Single lumen
Valved or non‐valved |
Basilic
Cephalic
Brachial | Used primarily for patients requiring several weeks or months of intravenous access |
| Short‐term percutaneous central venous catheter (non‐tunnelled) |
Polyurethane
Silicone | Heparin, antibiotic and antiseptic coatings; multiple lumen |
Jugular
Subclavian
Femoral | Intended for days to weeks of intravenous access |
| Skin‐tunnelled catheter (STC) |
Polyurethane
Silicone |
Valved or non‐valved
Antimicrobial/silver cuff
Multiple lumen
Computed tomography compatible |
Jugular
Axillary
Subclavian
Femoral | Indefinite: used for long‐term intermittent, continuous or daily intravenous access; may be appropriate for short‐term use if reliable access needed |
| Implanted ports |
Catheter: silicone or polyurethane
Port: titanium or plastic |
Single or dual ports
Peripheral or chest ports
Valved or non‐valved
Low profile
Computed tomography compatible |
Veins of the upper arm (basilic, brachial)
Jugular
Axillary
Subclavian
Femoral |
Indefinite: used for long‐term access
Intermittent, continuous or daily intravenous access |
