Central Venous Access Catheters (CVACs)

 

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. When you have a CVAC, you are spared the irritation and discomfort of repeated needle sticks. More than 3.4 million CVACs are placed each year, and doctors increasingly recommend their use. There are several types of CVACs, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters (also called PICC lines or long lines), dialysis catheters, and implantable ports.

Doctors often recommend CVACs for patients who regularly have:

• Chemotherapy treatments
  
• Infusions of antibiotics or other medications
  
• Nutritional supplements
  
• Hemodialysis

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