Methods Of Intravenous Access

There are number of routes to establish an intravenous access. Some of them are easier to perform and seen frequently in the clinical setup, but some are used in special circumstances and requires greater skill for insertion.

Methods Of Intravenous Access

  • Peripheral venous catheter
  • Central venous catheter
  • Tunneled lines
  • Subcutaneously Implanted Vascular Access
  • Peripherally Inserted Central Cannula (PICC)
  • Intraosseous line
  • Venous cut down
 

Peripheral Venous Catheter

  • Commonly used method of intravenous access to administer IV drugs and IV fluids
  • Easier to insert
  • Ranges from 12G to 24G
  • Large bore cannulae (14G) are required to administer fluid at a higher rate
  • Indications
    • Fluid infusion 
    • Blood and blood products transfusion
    • Drug administration 
    • Peripheral venous feeding
  • Contraindications
    • Administration of vaso-active drugs – Inotropes
    • Irritants – TPN
    • Local infection
  • Complications 
    • Infection 
    • Thrombophlebitis  
    • Extravasation 
    • Subcutaneous haematoma
  • Common sites 
    • Dorsum of hand
    • Cephalic vein, basilic vein
    • Median cubital vein 
    • External jugular vein 
    • Dorsum of foot
    • Long saphenous vein (Ankle)
    • Scalp veins in infants and neonates  
 


Central Lines

  • More difficult to insert | Can be inserted with the guidance of ultrasonography 
  • Central venous catheters are inserted into the superior vena cava / right atrium or inferior vena cava
  • Inserted using through cannula technique – Needle → Cannula → Catheter
  • Indications
    • Fluid infusion 
    • Drug administration – Cytotoxic drugs 
    • TPN
    • Inotropic drugs
    • Monitoring of CVP
  • Contraindications
    • Local infection 
    • Bleeding diasthesis
  • Common sites
    • Internal jugular vein (preferred)
    • Subclavian vein 
    • Long saphenous vein
  • Complications
    • Pneumothorax
    • Haemothorax 
    • Arterial damage 
      • Subcutaneous haematoma
      • AV fistula
      • Aneurysm 
      • Haemorrhage – In patients with coagulation problems 
    • Thoracic duct injury 
    • Brachial plexus injury
    • Central vein thrombosis and embolism 
    • Catheter occlusion 
    • Catheter related sepsis


Tunneled Lines

  • Inserted into internal jugular vein by ultrasonography guidance 
  • Hickman lines and Groshong lines are examples of tunneled lines
  • These catheters inserted percutaneously and the exit site is brought onto the chest wall and anchored to the surrounding tissue
  • Indications
    • Long term parenteral nutrition 
    • Chemotherapy 
    • Usually seen in paediatric age group 
 
Tunneled catheter
 
Subcutaneously Implanted Vascular Access
  • Port-a-cath and Infuse-a-port are examples of this system
  • Consist of a reservoir which is implanted subcutaneously and a catheter into IJV
  • Indications
    • Long term chemotherapy
    • Long term antibiotics
    • Children with less compliance to tunneled lines (Pulling the line out of the body)

Intraaosseous access

  •  Indications
    • Used as an emergency method of fluid resuscitation, specially in paediatric age group
  • Contraindications
    • Local infection 
    • Ipsilateral fractured extremity
  • Common sites 
    •  Anteromedial aspect of the proximal tibia
  • Complications
    • Misplaced needle
    • Epiphyseal plate damage
    • Local sepsis
    • Osteomyelitis

 

Peripherally Inserted Central Cannula (PICC)

  • Most popular method of central access
  • Similar to conventional central lines, but inserted into a peripheral vein to obtain central access
  • Comparatively less complications than conventional central lines 
 
Venous Cut Down
  • Surgically a peripheral cannula is inserted into a vein in patients with collapsed veins following hypovolemic shock
  • Indications
    • Patients in shock (Collapsed peripheral veins) with difficult cannulation
  • Common sites
    • Antecubital vein (Median basilic vein)
    • Long saphenous vein
  • Complications
    • Haemorrhage 
 
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