Before the Procedure

A CVAC is a tube that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally.

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia, or contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners for a specified period of time before your procedure.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

Equipment

In this procedure, x-ray and ultrasound equipment, a needle, a guide wire, and a vascular access catheter are used.

The equipment typically used for this examination consists of a radiographic table, an x-ray tube, and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier, which converts x-rays into a video image, is suspended over the table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film. The x-ray equipment allows the operator to watch the wire and catheter on a live display so they can be inserted safely and positioned to allow the catheter to function best.

Ultrasound scanners consist of a console containing a computer, a video display screen, and a transducer that is used to scan the body. Ultrasound is used to assess the vein that is being used for catheter placement and to provide guidance during the venous puncture. It is important to use ultrasound guidance during the venous puncture to reduce the risk of possible complications such as bleeding. Ultrasound also allows the physician to find the best vein to use, locating veins that are large but deeper than can be felt or seen.

A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti. In contrast to the catheter used in a standard intravenous (IV) line, a vascular access catheter is more durable and does not easily become blocked or infected. These catheters are designed in a way that they extend into the largest central vein near the heart. The following are the major types of vascular access catheters:

• A peripherally inserted central catheter (PICC) is a long catheter that extends from an arm vein into the largest vein near the heart, the superior vena cava, and typically provides central IV access for several weeks but may remain in place for several months. These catheters are called "midline catheters" when they are placed in a way that the tip of the catheter remains in a relatively large vein but does not extend into the largest central vein. They may have one or two lumens, and some may be able to be used for CT contrast injections (manufactured for forceful injections).
• A non-tunneled central catheter is larger caliber than a PICC and is designed to be placed via a relatively large, more central vein such as the jugular vein in the neck or the femoral vein in the groin.
• A tunneled central catheter has a cuff that stimulates tissue growth that will help hold it in place in the body. Examples of the tunneled catheter include the HICKMAN®, BROVIAC®, and GROSHONG® catheters. The tunneled catheter is the best choice when access to the vein is needed for a long period of time. It is secure and easy to access. They are more secure and usually work more efficiently than PICCs because of their design (cuff on the catheter stimulating tissue growth) and larger size. This type of catheter has portions that hang outside the skin and is used by connecting directly to the outside ports of the catheter. The patient does not get stuck directly when the catheter is used. This type of catheter must be protected from getting pulled or getting wet.
• A port catheter, or subcutaneous implantable port, is a permanent device that consists of a catheter attached to a small reservoir, both of which are placed under the skin similar to tunneled catheters. This catheter is used completely under the skin. The patient's skin is punctured every time the catheter is used, but there are no restrictions on showering or bathing.

Note: HICKMAN®, BROVIAC®, and GROSHONG® are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.

A small hollow needle and long, thin wire, called a guide wire, help the physician position the catheter.

Other equipment that may be used during the procedure includes an intravenous (IV) line and equipment that monitors your heart beat and blood pressure.

• Devices to monitor your heart rate and blood pressure will be attached to your body.
• You will feel a slight pin-prick when the needle is inserted into your vein for the intravenous (IV) line and the local anesthetic is injected. After that, the skin will be numb, and you will only feel pressure.
• If the case is done with sedation, the IV sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
• You may feel some pressure or brief discomfort when the needle is placed into the vein and when the tunnel is created. The sensation is very brief.
• You will have to lay flat for about 30-45 minutes during the catheter placement.
• In the recovery area, your first dose of antibiotics may be given. If you had no sedation, you will go home within an hour. If you had sedation, you will go home after 2 hours.
• You should rest at home for the remainder of the day following the procedure. You may resume your usual activities the next day, but you should avoid lifting heavy objects.
• After having a tunneled catheter or subcutaneous port placed, you may experience bruising, swelling, and tenderness in the chest, neck, or shoulder, but these symptoms clear up in a few days. Pain medicine may help during this time.
• You will receive instructions on how to care for your incision(s) and your particular vascular access device. For the first week, it is especially important to keep the catheter site clean and dry. Some (but not all) physicians will recommend sponge bathing around the catheter site, then cleaning the area with peroxide, applying an anesthetic ointment that contains an antibiotic, and bandaging the area.
• You may be allowed to shower after one week, using a piece of plastic wrap over the site where the catheter was inserted. You should not allow the incision to be held under water by swimming or soaking in a tub.
• You may be advised to flush your catheter with heparin solution, which may help keep blood clots from forming and blocking the catheter.

You should call the physician or nurse if you have any questions about your vascular access device or if:

• the device malfunctions.
• there is bleeding at the insertion site or signs of infection.
• you develop a fever.
• you notice redness, increased swelling, tenderness, warmth, or fluid drainage at the catheter insertion site.

Removal