Patients who need long term or specialized intravenous therapy may get a central venous access device or CVAD inserted to receive these medications. A peripherally inserted central catheter,or PICC line, is one of four types of CVAD access lines. These devices have one end positioned outside the body with a hub to connect with the medication tubing. The other end of the tubing lies within the subclavian, femoral or jugular vein.
A PICC line is inserted in the upper arm. Specially trained nurses, physician assistants or radiologists use an ultrasound machine to find a large vein in the upper arm. The PICC line is then inserted, and a chest X-ray obtained to confirm correct placement in the superior vena cava. A sterile dressing goes over the skin at the insertion site to prevent infection. Once confirmed, nurses can use the PICC line to give intravenous medications, and to draw blood for lab tests.
Tunneled and Non Tunneled CVADs
Doctors or surgeons insert tunneled and non tunneled CVADs. A non tunneled CVAD goes into major veins in the neck, chest wall or groin. The tip lies in the vein, and the lumens exit the skin near the access site. Tunneled CVADs are inserted through the chest wall. Once the tip is in the vein, doctors use a special instrument to create a tunnel under the skin of the chest. Next, the tubing is threaded through this area and a suture holds it in place.
This is a special type of CVAD that is inserted when access is needed for many months or years. The entire device remains under the skin on the chest. The tip lies in the subclavian vein, and the opposite end is a small reservoir. A special needle punctures the skin over the reservoir to gain access.
Risks and Benefits
Injury from the actual procedure of having a CVAD placed can cause a lung to collapse, pneumothorax, or bleeding into the chest, hemothorax. Infection at the insertion site, bacteria in the bloodstream and blood clots in the vein with the PICC line are some common complications. Pneumothorax or hemothorax are medical emergencies and need immediate treatment. The symptoms develop immediately after placement and the medical professional performing the procedure is trained to manage these emergencies. CVADs offer benefits for people receiving long term medication therapy. They do not need repeated I.V. access insertions. CVAD lines are easily maintained at home, and can be easily hidden under a shirt.