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IV Access

In the hospital, we often need to be able to put fluids or medications directly into your vein. So, you need "INTRA venous access".  We only put medications into the veins.  Medications never go into the arteries.

There are several options for different situations listed below.

PIV – Peripheral intravenous access.  This is the small often called a butterfly needle, they put in your arm that stays there.  Fluids can go in.  Blood does not come out.  They often fall out of the vein and cause pain when your IV is infusing. This is called “infiltrating”.  These are the most common form of access in the hospital.

  • These IVs can last 3-5 days

  • Higher risk of infection than other access 

  • Pain is mild when inserting IV

  • It can take minutes to be placed

  • They are easily pulled out and often fall out on their own

Midline  A longer term access often placed by a dedicated team of nurses. They last longer than a peripheral IV but not as long as a PICC.  It is usually placed in the upper arm 

  • Sometimes you can draw blood off of midline

  • There is minimal pain when it is placed as there is numbing medicine used 

  • They can last for 2-6 weeks

  • It can take less than 30 minutes to place this line

 

PICC – Peripherally Inserted Central Catheter.  This is placed by a dedicated team of nurses using an ultrasound to find the vein, usually in the upper arm.  They use sterile technique so you will be cleaned and drape will be placed over your body so there is less risk of infection.  It is considered a “central line”. People can leave the hospital with these in place for home medications, or outpatient infusion  

  • PICCs can remain in place for months

  • There is minimal pain as numbing medicine is used before placement

  • It can take 30 minutes to place this line, if all goes well 

  • It is easily removed by a nurse when you do not need it

  • It has low risk of infection

  • The best part of a PICC line is that blood work can be drawn off the PICC line so you do not need to be poked every morning for your lab work

 

PORT - Often referred to as a Port a cath.  It is placed by a surgeon in the operating room as a minor procedure.  It is placed under the skin.  Nurses can use needles to poke through the skin to access this.  Some of these ports have a single-lumen or can have two lumens.  A single lumen can give one medication at a time.  A double-lumen allows two medications to be run at the same time. A “Power PORT” can withstand higher injection pressures.  Higher pressures are needed for things like contrast dye before a CT scan.  These are usually placed when you need chemotherapy.

  • There is minimal pain with this procedure, as numbing medication is given

  • The procedure takes less than 30 minutes

  • The skin generally heals in several days 

  • They have low risk of infection and can last for years

  • It is removed by a surgeon with a small incision

 

Central Line - When you are very sick (unstable) and your blood pressure is low it is hard to get venous access.  Some medications require a larger diameter of venous access to place medications, “large-bore”.  Some medications can damage veins.  A central line allows access to larger vessels near the heart.  This can be placed in the emergency room or at the bedside in the intensive care unit.  It is usually placed by a physician.  In difficult cases by the anesthesiologist or surgeon. They can be placed in your neck, internal jugular vein, the femoral vein in the groin or directly under the clavicle bone.  Some physicians use ultrasounds to help place these.

  • They can placed in about 30 minutes

  • There is minimal pain with the procedure as numbing medicine is given

  • They have less risk of infection then a peripheral IV

  • We use these typically for one week, then change to a more permanent access, as above, if needed

 

Intraosseous (IO) - This is a vascular access type that goes directly into the bone.  It is not commonly seen as it is extremely painful to be placed.  It works very well.

  • It is placed just as fast as a peripheral IV

  • It can only stay in 24 hours

  • Is extremely painful to be placed

 

Hemodialysis (HD) Catheters - There are many different hemodialysis catheters that can be placed when you need to have emergency hemodialysis.  Hemodialysis is needed when your kidneys are not functioning anymore (Acute Renal Failure), or if you need toxins removed quickly.  If you progress to chronic kidney disease, eventually you have a planned arteriovenous (AV) fistula made by a vascular surgeon in the OR.  HD catheters are placed in the OR and tunneled under the skin.  This reduces the chance of infection.  They are generally placed in the chest. There are more permanent catheters able to be placed for long-term dialysis, if an AV fistula is not possible.

  • Temporary catheters can last 1-4 weeks

  • It can take between 30 and 40 minutes to place a catheter in the OR, but if emergency use is needed they can be placed just like a central line above

  • Numbing medicine is used prior to insertion so there is minimal pain

  • Removed by a vascular surgeon or occasionally a Nephrologist (kidney doctor)

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