Venous Access

Repeated punctures can damage your blood vessels (veins). Venous access helps your doctor administer medicines directly into your bloodstream without repeatedly piercing your blood vessels. Venous access is obtained by means of a catheter (thin flexible tube) that acts as an entrance into your vein. Catheters have one end placed in a vein, usually in the arm, neck, or chest, and the other end exiting your body through which your doctor can administer medicines into your body. Some patients may have a circular device called a port which is placed under the surface of your skin and connected to the delivery end of your catheter.

Indications

Venous accesses are indicated in patients with regular need of injections over a long period of time. They are often used in patients on chemotherapy, severe infections needing long-term antibiotic treatment, haemodialysis, blood transfusions, and fluid or nutritional supplementation.

Venous accesses are designed in such a way that they do not irritate your vein and are made of special soft materials that can remain in your body safely for weeks or months.

Types of Venous Accesses

Different types of venous accesses are used to treat different conditions. Depending on your specific condition, your doctor may use any of the following venous accesses:

• Peripheral venous catheters (PVC). Also referred to as an IV (intravenous) line, these are placed in the peripheral veins of the arm or the hand and left in place for a short period of time
• Peripherally inserted central catheters (PICC). PICCs are longer than PVCs and can be inserted in your arm and left there for a longer period of time
• Tunnelled catheters. These are placed directly into a large vein near the heart (vena cava) through an opening in your chest and can be left in place for several months
• Subcutaneous vascular access devices (SVADs). SVADs are small circular devices inserted under the skin of your chest and can be left in place for an indefinite amount of time

Preparing for the Procedure

No special preparation is required for the insertion of a venous access. Your doctor will advise you on any special instructions for your specific condition. In order to determine the health of your veins before having a venous access, your doctor may obtain diagnostic tests such as a chest x-ray, duplex ultrasound, venogram, or MRI.

Procedure Description

Depending on the place of insertion and the type of access, a venous access procedure may last from 30 to 45 minutes. Some procedures may be performed under local anaesthesia and some may require mild sedation. During the procedure, your surgeon will puncture your vein, insert a catheter and close the point where the catheter comes out of your body.

An SVAD or a tunnelled catheter will require a minor surgery, where your surgeon will create a small pocket in your chest to place the port (a small round device that connects to the catheter in the vena cava).

Recovery

After your procedure, you will stay in the recovery area for about an hour. You will not be able to drive and you will have to arrange for someone to accompany you home until sedation clears. You can resume all your normal activities from the next day. You will need to keep your catheter insertion and exit sites clean and dry. You may be prescribed antibiotic ointment to be applied at the incision site. Stitches if any will be removed in about 7 to 10 days. Your doctor will advise you on further instructions regarding catheter care.

Complications

Complications are usually minor and will go away in the next few days. Some of the potential complications include bleeding, bruising, and swelling. Some of the serious complications include formation of air bubbles/clots in your vein, arrhythmias, puncture in a major artery or vein, and infection (sepsis). Contact your doctor immediately if you have fever, swelling in your extremities, laboured breathing, inflammation or bleeding from the catheter insertion or exit site.