Benefits vs. Risks of Vascular Access Procedures
Vascular Access Procedure Benefits
A central catheter permits infusion of solutions containing medication or nutritional substances without causing the complications that may occur with an IV, such as local tissue damage when a toxic drug leaks out of the vein.
In many conditions, having this type of tube inserted provides a simple and painless means of drawing blood, or delivering drugs, nutrients or both.
Vascular access devices spare the patient the discomfort and stress of repeated needle sticks.
The vascular access device is an extremely useful solution for patients who—for any reason—require repeated entry into the venous circulation over a long period. A number of different designs are available that are suitable for different circumstances.
Placement of a vascular access device is a great solution for those requiring prolonged treatment such as chemotherapy. They will not need to have an IV line placed for each treatment and their arm veins will not become badly scarred.
A PICC is very helpful when medicines or fluids that are irritating to the wall of the vein are needed. A wide range of products may be given by this route, including antibiotics and blood products, and the catheter also may be used for IV feeding and frequent blood sampling.
A vascular access device may be used immediately after placement. Some types will continue functioning well for a year or longer. The devices are easily removed when no longer needed.
A catheter sometimes is the only way of getting access to the circulatory system for hemodialysis in patients with serious kidney disease.
Vascular Access Procedure Risks
Two types of risk are associated with vascular access devices: those occurring during or shortly after placement and delayed risks that occur simply because the device is in your body.
Following are some of the risks associated with placement of a vascular access device:
Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
An infection may develop at an incision site shortly after catheter placement. The risk is less if you carefully follow instructions about caring for the incisions as they heal.
Bleeding (hemorrhaging). This risk can be minimized through a blood test in advance to be sure that your blood clots normally. If it does not, the procedure may be postponed or you may receive medication or blood products to improve blood clotting.
Very rarely a patient may develop a condition called a pneumothorax, a collection of air in the chest that may cause one of the lungs to collapse. This may occur during placement of a catheter or port using a vein in the chest or neck, but not when an arm vein is used. The risk is lessened when catheter placement is guided by ultrasound or fluoroscopy. This is why these catheters should be placed by an interventional radiologist using appropriate imaging guidance during the procedure.
The normal heart rhythm may be disturbed while the catheter is inserted, but this is usually only temporary. The problem is easily recognized during the procedure and eliminated by adjusting the catheter position.
Rarely, the catheter will enter an artery rather than a vein. If this happens, the catheter will have to be removed. Most often the artery then heals by itself, but occasionally it has to be surgically repaired.
Two types of delayed infection may develop: skin infection at the catheter or port insertion site or bloodstream infection. Infections are least common after placing a port. The risk of delayed infection can be minimized if you and anyone else who will be handling the device wash hands before flushing it or cleaning the insertion site. The site should be carefully inspected each time the dressing is changed. The risk of infection is higher for individuals who have low white blood cell counts.
A hole or break in the catheter may lead to leakage of fluid. Breaks may be avoided by not always clamping the catheter in the same spot and by never using too much force when flushing it. Two important first aid measures: 1) clamp the catheter between the damaged part and the skin insertion site; 2) tape a sterile gauze pad to the skin to cover the break. Catheters rarely fracture inside the body. A chest x-ray will show a fracture and allow removal of the broken fragment without surgery.
The catheter may become accidentally dislodged. If the catheter is not secured to the skin appropriately, it may come out. If this happens, you should apply pressure to the incision site using a sterile dressing and call your physician immediately.
A large amount of air in the catheter may create an emergency that causes chest pain or shortness of breath. If you develop chest pain or shortness of breath related to air being pushed into the vein through the catheter, you should clamp the catheter right away, lie on your left side and call 9-1-1. This problem can be avoided by always clamping the catheter before and after inserting a syringe, and by making sure that the catheter cap is screwed on tightly.
Any type of vascular access catheter may become obstructed by clotted blood or fibrin sheath. You can minimize the risk by carefully following instructions about flushing the catheter. Once a catheter occludes, or becomes closed off, it sometimes can be cleared by injecting medication but at other times must be removed or exchanged for a new catheter. Occasionally the catheter can be stripped by a simple interventional procedure.
If the vein in which the catheter lies becomes occluded (closed off) the arm, shoulder, neck or head may develop swelling. If this occurs, call your physician immediately. The clot may be treated by a blood-thinning medication, but occasionally the catheter will have to be removed.
Rarely, patients experience a sensation of skipped or irregular heartbeat that may be related to the catheter. Call your physician if this occurs. The catheter tip may need to be readjusted slightly to relieve this.