The Ins and Outs of Venous Access: Part II

Selection of the proper venous access device is important to maximize patient benefit and minimize patient discomfort, morbidity, mortality, and cost. The decision of which device to use is based on whether or not the patient requires central venous access and whether the need is short-term ( 6 to 8 weeks) or long-term. Shortterm venous access devices include short peripheral IV catheters, midline catheters, peripherally inserted central catheters (PICC), and central venous catheters (CVC). This article reviews each of these short-term devices and their indications, contraindications, advantages, and disadvantages. Part 1 covers Venous Anatomy and Short-Term Venous Access; Part 2, to be published in the June issue, covers Long-Term Venous Access. More than 150 million vascular access devices (VAD) are purchased annually in the United States, at a cost of approximately $840 million. Of these, 5 million are central venous catheters (CVC) or pulmonary artery catheters. Approximately 500,000 long-term CVC are inserted in the United States annually, mainly for chemotherapy and parenteral nutrition (PN). Although there is no absolute cutoff, long-term CVC are indicated when venous access is required for more than 6 to 8 weeks. Before discussing the options for short-term VAD, the venous anatomy will be briefly reviewed.