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Central Venous Access | Dr Ryan McConell

Conditions we treat

Central Venous Access

What is central venous access?

Central venous access allows the administration of long-term therapies requiring extended venous access and a number of therapies that cannot be delivered through peripheral access.

Dr McConnell works closely with cancer specialists, renal specialists and other doctors to provide high-quality vascular access service to ensure patients undergoing long-term treatment can maintain their intravenous access and receive the treatment they need.

Vascular access line insertions are performed under ultrasound and x-ray guidance. Local anaesthetic and sedation are administered to ensure patients are comfortable during the procedure. The procedure is quick taking approximately 20 minutes. Patients are able to go home approximately 1-2 hours after the procedure.

There are 4 types of central venous access:

  1. Portacath
  2. Tunnelled central catheter
  3. Non-tunnelled central catheter
  4. Peripherally inserted central catheter

Portacath

A Portacath is a good option for patients requiring long-term venous access with infrequent use (e.g. chemotherapy). Portacaths take away cancer patients anxiety related to repeated attempts at venous access when requiring chemotherapy. The port is accessed through the skin using a special needle and medicines can then be injected safely and also blood taken for blood tests.

 

Procedure

A Portacath is a type of vascular access line that is completely contained under the skin. The portacath has a small chamber that is inserted beneath the skin on the upper chest. A catheter (hollow tube) is attached to the chamber and passes under the skin up over the collarbone into a vein in the neck (internal jugular vein) and then down into a large vein within the chest. The procedure takes approximatley 25 minutes and is performed as a day procedure.

Risks

The insertion of a Portacath is a minimally invasive procedure and has very low associated risks. Rare risks include infection, fibrin sheath formation and catheter related thrombosis.

 

Recovery/Aftercare

After the sedation has worn off and you have been observed for a few hours you will be able to go home. You will need to have someone pick you up as you will not be able to drive for the rest of the day following the sedation.

It is important to keep the wound clean and dry especially for the week following the procedure. You will then be able to remove the dressing. It is advised you avoid any strenuous activity of the upper limb and chest to allow the wound to heal. Once the incision site where the port has been inserted has healed, patients are able to return to their normal activities including swimming, showering and sports.

Tunnelled central catheter

Tunnelled central catheter is indicated when long-term venous access with frequent use is required (for example, antibiotics, TPN, transfusions, blood sampling, dialysis etc.).

 

Procedure

The procedure is performed under local anaesthetic. Tunnelled central catheters enter the vein at one location and exit the skin at a different location. The catheter is inserted through the skin and runs under the skin within the fat layer before entering a vein and using the plumbing of the veins the tip of the catheter is placed within a large vein in the chest. The catheter has a small cuff which is located within the fat layer near the skin insertion site. This cuff promotes ingrowth of surrounding tissues, anchoring the catheter in place and possibly providing a mechanical barrier to bacterial migration.

The procedure takes approximately 20 minutes and is performed as a day procedure.

Risks

The insertion of a tunnelled catheter is a minimally invasive procedure with extremely low associated risks. Rare risks include infection, fibrin sheath formation and catheter-related thrombosis.

 

Recovery/Aftercare

After the procedure, patients will be observed for a short period of time and then will be able to go home. It is important the insertion site remains clean. After the procedure patients will receive device self-care instructions/education.

Non-tunnelled central catheter

Indications for insertion of a non-tunnelled central catheter include:

  1. Short-term venous access when peripheral IV access is not suitable.
  2. Volume resuscitation
  3. Central venous pressure monitoring
  4. Short-term dialysis

 

Procedure

Under ultrasound guidance, a central venous catheter is inserted into a central vein (for example, internal jugular vein) and the catheter tip is advanced under x-ray guidance into a large vein within the chest (superior vena cava or atriocaval junction).

Risks

Non-tunnelled central catheter insertion is a low-risk minimally invasive procedure. However, rare risks include infection, bleeding at the insertion site and catheter-related thrombosis.

 

Recovery/Aftercare

After the procedure, patients are monitored for a short period of time. It is important the insertion site remains clean. After the procedure patients will receive device self-care instructions/education.

Peripherally inserted central catheter (PICC)

PICC lines are indicated when frequent venous access is required in the short to long term (antibiotics, TPN, transfusions, blood sampling etc.).

 

Procedure

Under ultrasound guidance, a PICC line is inserted into a peripheral vein (e.g. basilic vein) and advanced under x-ray guidance to a large vein within the chest (superior vena cava or atriocaval junction).

The procedure takes approximately 20 minutes and is performed as a day procedure.

Risks

PICC line insertion is an extremely low-risk minimally invasive procedure. However, rare risks include infection, bleeding at the insertion site and catheter-related thrombosis.

 

Recovery/Aftercare

After the procedure, patients are monitored for a short period of time. It is important the insertion site remains clean. After the procedure patients will receive device self-care instructions/education.

Book an appointment and take control of your vein health.