Different Types of IV and Dialysis Accesses

By Emily Weatherford MSN RN

Types of IV accesses

Peripheral • Simple

• Inexpensive

• Used for short-term therapy

• Site has to be rotated every 72-96 hours

Central• Used for long-term medication, IV fluid,

blood product therapy

• Used when patient requires large quantities of IV fluids, blood or medication

• Administration of harmful medications like chemotherapy

• Poor or inaccessible peripheral venous access

Peripherally Inserted IV catheters

Midlines

• Midline catheters are inserted into the antecubital (or other upper arm) vein. They are typically 20 cm long and their tips do not reach the central veins of the thorax so they are considered peripheral accesses not central lines.

• Used for IV therapy 1-4weeks

• Not recommended for vesicants or highly irritating medications such as chemotherapy

Midline

Central Lines

Types of Centrally Inserted Catheters

• Skin-tunneled catheters

• Non-tunneled catheters

• Implanted ports

Skin-tunneled Catheters

• (Hickman or Groshong catheters) more long-term; reduces the incidence of infection by increasing the distance between the skin entry site and the venotomy; complications include thrombosis, occlusion, and infection

Non-tunneled Catheters

• (Quinton catheters) short-term access in the emergency room, operating room and intensive care unit; used for rapid rescusitation and pressure monitoring; can be used for short-term dialysis

Implanted Ports

• (Lifeports, Powerports) consists of a catheter attached to a reservoir that is implanted into a surgically created pocket on the chest wall or upper arm

PICC Lines

Peripherally Inserted Central Catheter (PICC)

• Inserted in the basilic, cephalic, or brachial veins

• Easier and safer insertion than centrally inserted catheter

• Used for long-term therapy from several weeks to 6 months

• Can be used for long-term chemotherapy, parental nutrition, blood products, antibiotics and other medication therapy

• Complications include dislodgment, occlusion, mechanical phlebitis, and deep vein thrombosis (DVT)

Dialysis Accesses

Types of Hemodialysis Accesses

• Long-term access (Assess for thrill and bruit)

• AV graft

• AV Fistula

• Temporary access (No thrill or bruit)

• Dialysis catheter

Arteriovenous Fistula (AV fistula)

• Lasts the longest, years

• Requires surgery to connect artery to vein and takes the longest to develop, may take as long as 24 months before it can be used for dialysis

• Less likely to form clots or get infected

• Nurse should assess for thrill and bruit

Arteriovenous Graft• Can last several years if well cared for but more likely than

fistulas to get clotted or infected

• Requires surgery to connect an artery to a vein using a synthetic tube, or graft

• Can be used for patients with small veins that will not be able to develop a fistula

• Takes less time to heal 2-3 weeks; Nurse should assess for thrill and bruit

• For long-term dialysis

Dialysis Catheters

• Used when there is an immediate need for dialysis

• Not for permanent use

• Tunneled catheters can be used for longer-term dialysis, longer than 3 weeks but still prone to infection

• Can be inserted in the neck, chest or groin

Reference

• Cheung, E., Baerlocher, M. O., Asch, M. (2009). Venous Access. Canadian Family Physician. 55(5), 494-496. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682308/