IV Therapy
By Jean Chiang RN (graduate student at Emory University School of Nursing)
Placed here with permission from John Summerville BA, BSN, MN  Assistant Professor
Georgia Baptist College of Nursing

This page contains explanations of some IV access devices as well as pictures of IVs and sites with problems.  



Types of IV access

The Hickman catheter is softer than a simple triple-lumen catheter, and is usually inserted in an operating room. The actual access to the subclavian vein is still by puncture under the clavicle, but the distal end of the catheter is pulled under the skin for 2-4 inches and comes out of the chest close to the nipple. This creates a "tunnel" which decreases the risk of infection. The Hickman catheter, which is made of silastic (a silicone elastomere), comes in double-lumen and triple-lumen varieties. These catheters can stay in place for weeks to months; some patients have had the same Hickman catheter for years!

The Groshong catheter is very similar to the Hickman catheter, but has a valve at the tip of the catheter which makes it unnecessary to leave a high concentration of heparin in the catheter (see below). The Broviac catheter is also similar to the Hickman catheter, but is of smaller size. This catheter is mostly used for pediatric patients.

Pheresis catheters are larger and sturdier than Hickman catheters. Pheresis catheters can also be used for hemodialysis, and are often called "dialysis catheters". The Hickman catheters are not designed to handle high-flow blood withdrawals; they are so soft that the walls of the catheter collapse (pull vacuum) when the dialysis, or pheresis, machine attempts to pull blood into the machine (see also Apheresis). These dialysis/pheresis catheters can either be inserted without a tunnel (e.g., Arrow Catheter?/i>) at the bedside, or with a tunnel (e.g., PermCath?/i>) in the operating room. Such tunneled pheresis catheters can serve both for the collection of stem cells and for support of the patient during the transplant episode.

Implantable Ports are catheters which are inserted completely under the skin. The distal end of the catheter is formed by a small metal "drum" or reservoir, which has on one side a membrane for needle access. This drum is surgically placed under the skin, just below the clavicle, with the membrane immediately below the skin. The catheter runs from the drum into the subclavian vein. Access is always with a special needle that is pushed through the skin and the membrane into the reservoir inside the drum. Such ports come in different sizes, and can have either one or two lumens. Since the entire catheter is under the skin, the risk of infection is smaller than with external catheter

Pictures of IV Access Devices

Peripheral IV (INT, HL, Angiocath, etc)
Multi-Lumen Central Catheter
*Above: Triple-lumen Central Catheter
  Below: Quad-lumen Central Catheter
Implantable Vascular Access Devices (Port-A-Cath; PAS Port)
Implantable Ports are catheters which are inserted completely under the skin. The distal end of the catheter is formed by a small metal "drum" or reservoir, which has on one side a membrane for needle access. This drum is surgically placed under the skin, just below the clavicle, with the membrane immediately below the skin. The catheter runs from the drum into the subclavian vein. Access is always with a special needle that is pushed through the skin and the membrane into the reservoir inside the drum. Such ports come in different sizes, and can have either one or two lumens. Since the entire catheter is under the skin, the risk of infection is smaller than with external catheter
*From left to right: Single Lumen Port; PAS Port; Duel Lumen Port; Quarter; Duel Lumen Port
VasCath
Pheresis catheters are larger and sturdier than Hickman catheters. Pheresis catheters can also be used for hemodialysis, and are often called "dialysis catheters". The Hickman catheters are not designed to handle high-flow blood withdrawals; they are so soft that the walls of the catheter collapse (pull vacuum) when the dialysis, or pheresis, machine attempts to pull blood into the machine (see also Apheresis). These dialysis/pheresis catheters can either be inserted without a tunnel (e.g., Arrow Catheter?/i>) at the bedside, or with a tunnel (e.g., PermCath?/i>) in the operating room. Such tunneled pheresis catheters can serve both for the collection of stem cells and for support of the patient during the transplant episode.
*Above: VasCath
  Below: Tip of VasCath
Percutaneous Intravenous Catheter
Hickman Catheter
The Hickman catheter is softer than a simple triple-lumen catheter, and is usually inserted in an operating room. The actual access to the subclavian vein is still by puncture under the clavicle, but the distal end of the catheter is pulled under the skin for 2-4 inches and comes out of the chest close to the nipple. This creates a "tunnel" which decreases the risk of infection. The Hickman catheter, which is made of silastic (a silicone elastomere), comes in double-lumen and triple-lumen varieties. These catheters can stay in place for weeks to months; some patients have had the same Hickman catheter for years! 
Groshong Catheter
The Groshong catheter is very similar to the Hickman catheter, but has a valve at the tip of the catheter which makes it unnecessary to leave a high concentration of heparin in the catheter (see below). The Broviac catheter is also similar to the Hickman catheter, but is of smaller size. This catheter is mostly used for pediatric patients. 
Huber Needles

Problems With IV Therapy

Infusion Phlebitis - inflammation of the vein associated with infusion phlebitis is seen in this photograph. Careful/regular monitoring of intravenous access sites is recommended.

Infection - adhering to aseptic technique is vital in the prevention of intravenous related infections. Asepsis should be maintained at insertion, during clinical use and at removal of the device.

Bruising - may occur at any time during an episode of intravenous therapy.

Extravasation - the inadvertent administration of a vesicant substance into the tissues can have disastrous outcome.

Infiltration- regular monitoring of infusion sites, choice of correct access device/intravenous dressing and the use in-line pressure monitors may help to reduce the extent to which infiltration occurs.


 

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    July 13, 2004