For many patients requiring frequent or continuous intravenous therapy, standard peripheral IV access is insufficient due to potential vein irritation and difficulty with repeated access, especially with certain medications like chemotherapy. This necessitates the use of long-term venous access devices, commonly referred to as Central Venous Catheters (CVCs) or central lines. These devices offer reliable access to the central circulation for extended periods.
Types of Long-Term Intravenous Access Devices
Implanted Ports (Port-a-cath, Mediport)
Implanted ports are CVCs placed entirely beneath the skin, typically in the chest or arm, via a minor surgical procedure. They consist of a port connected to a catheter leading to a central vein. Access is gained by inserting a special needle through the skin into the port. When not in use, there are no external parts. Ports offer a lower infection risk and allow normal activities like bathing and swimming once healed. They are suitable for months or years of use for various therapies and require periodic flushing to prevent clots.
Tunneled Catheters (Hickman, Broviac)
Tunneled catheters are CVCs for intermediate-term use (weeks to months). Part of the catheter remains outside the body. Inserted into a large vein and tunneled under the skin to an exit site, a cuff helps secure the catheter and prevent infection. The external end may have multiple openings for different treatments. The tunneling and cuff lower infection risk compared to non-tunneled catheters. However, the external portion requires daily care and must be kept dry.
Peripherally Inserted Central Catheters (PICC Lines)
PICC lines are central catheters inserted into a peripheral arm vein and advanced into a central vein. They are used for intermediate-term therapy (weeks to months). Placement is often done by a trained nurse at the bedside. A portion remains outside the arm and needs dressing protection. PICC lines are less invasive to place than tunneled catheters or ports and are useful for extended antibiotic courses or other medications irritating to smaller veins. Similar to tunneled catheters, the external part requires daily care and cannot get wet.
When is Long-Term IV Access Needed?
Long-term intravenous access is vital for consistent drug delivery in various pharmacological contexts, including:
- Chemotherapy and cancer treatments: Reliable delivery of potentially irritating medications over long periods.
- Long-term IV antibiotics: Treatment for severe or chronic infections requiring prolonged IV therapy.
- Total Parenteral Nutrition (TPN): Providing nutrients intravenously when oral intake is not possible.
- Repeated blood draws: Avoiding multiple needle sticks for frequent blood sampling.
- IVIG Therapy: Administering intravenous immunoglobulin.
Comparison of Long-Term IV Access Devices
| Feature | Implanted Port | Tunneled Catheter | PICC Line |
|---|---|---|---|
| Visibility | Completely under the skin, leaving a small bump. | External tubing visible at exit site. | External tubing visible at exit site on the arm. |
| Duration | Months to years, designed for long-term use. | Weeks to months. | Weeks to months. |
| Placement | Surgical procedure in the operating room or radiology suite. | Surgical procedure. | Typically placed at the bedside by a trained nurse or provider. |
| Maintenance | Accessed with a special needle; monthly flushing required when not in use. | Requires daily flushing and dressing changes. | Requires daily flushing and regular dressing changes. |
| Infection Risk | Generally lower risk due to being under the skin. | Lower than non-tunneled CVCs but higher than ports due to external portion. | Lower risk than other central lines, but external portion is still a risk. |
| Activity | Normal bathing and swimming possible once healed. | Cannot get wet; bathing requires special covers. | Cannot get wet; bathing requires special covers. |
Pharmacological Considerations
Long-term access devices offer pharmacological benefits such as facilitating delivery of high-volume fluids, multiple medications simultaneously, and substances irritating to peripheral veins. Placing the catheter tip in a large central vein ensures rapid dilution, reducing the risk of phlebitis. However, risks like catheter-related bloodstream infections (CRBSIs) are a concern, requiring strict sterile technique. The possibility of blood clots (thrombosis) is also present, and the choice of device involves weighing benefits against these potential complications.
Conclusion
While a standard IV is temporary, what is often called a permanent IV is medically known as a Central Venous Catheter (CVC). This category includes implanted ports, tunneled catheters, and PICC lines, all providing reliable, long-term access for medication delivery and other needs. Device selection depends on treatment duration, medication type, and patient lifestyle. These devices significantly improve patient comfort and safety, enabling efficient administration of vital medications. Understanding these options is important for patients and caregivers. For further information, the American Cancer Society website (cancer.org) provides resources on IV lines and ports.
