What to Expect During a Vascular Access Procedure
A midline catheter and some peripherally inserted central catheter (PICC) lines may be inserted at your bedside without image guidance. These are inserted through a vein near the elbow and threaded through a large vein in the upper arm.
Other vascular access procedures are most often performed by a specially trained interventional radiologist.
These procedures are often done on an outpatient basis.
You will be positioned on your back.
A nurse or technologist may insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. PICC placement usually does not require sedative medications.
The area of your body where the catheter is to be inserted will be shaved (typically the upper chest for tunneled catheters and in the arm for PICCs), sterilized and covered with a surgical drape.
Your doctor will numb the area with a local anesthetic.
A small nick is made in the skin at the site.
PICC: To place a PICC line, the doctor will identify the vein using ultrasound or X-ray guidance and insert a small needle into the arm vein and advance a small guide wire into the large central vein, called the superior vena cava, under X-ray (fluoroscopy). The catheter is then advanced over the guide wire and moved into position. The guide wire is then removed. If this is done without X-ray guidance, a chest x-ray is needed to confirm the catheter position.
NON-TUNNELED CENTRAL CATHETER: These catheters are placed via a relatively larger vein such as the jugular vein in the neck or femoral vein in the groin.
TUNNELED CATHETER: For a tunneled catheter, the doctor will make one small nick in the skin commonly in the lower neck. Using ultrasound guidance, the vein is punctured with a needle (usually the jugular vein at the base of the neck), and a small guide wire is advanced into the large central vein, called the superior vena cava, under X-ray guidance (fluoroscopy). A second small skin incision may be made below the first, and a tunnel under the skin is then created. Using X-ray guidance, the catheter is placed through the tunnel into the vein, and the tip of the catheter is placed into the largest vein, the superior vena cava. The cuff, which is typically made of Dacron®, is located on the tunneled part of the catheter. Finally, the physician will place stitches at end of the tunnel to help keep the catheter firmly in place. The stitches do not typically need to be removed until the catheter is taken out.
PORT-CATHETER: Implanting a subcutaneous port generally requires two incisions (except in the arm where a single incision may suffice). The port reservoir is placed under the skin. A small skin incision about two inches long is made, and a small pocket for the port is created under the skin. The rest of the procedure is similar to the tunneled central catheter placement. A small, elevated area remains on your body at the site of the reservoir. The port, which passes from an access site in a vein of your arm, shoulder or neck, ends in a large central vein in the chest. The reservoir has a silicone covering that can be punctured with a special needle.
Incisions are held together by stitches, surgical glue and/or a special tape.
An X-ray may be performed after the procedure to ensure the catheter is positioned correctly.
Your I.V. will be removed.
The implanted vascular access catheter is then ready for use.
For pediatric patients, a smaller catheter or other equipment may be used. A lower radiation dose in X-ray equipment will be used to guide the placement of the catheter.
Pediatric procedures are more commonly done with deeper sedation, possibly with the assistance of an anesthesiologist. Your child may be required to have nothing to eat or drink for up to six hours before the procedure. You will be given detailed instructions depending on the age of your child.
Let your physician know about any medication, X-ray dye or latex allergies your child may have, as well as previous responses to sedation. If your child has had previous vascular access devices, previous surgery in the same area, or has unusual anatomy, let your doctor know so they can plan the best location for the device.
You will feel a slight prick when the needle is inserted into your vein for the I.V. and when the local anesthetic is injected.
If the case is done with sedation, the I.V. sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
You may feel some pressure or brief discomfort when the needle is placed into the vein and when the tunnel is created.
You will have to lay flat for about 30 to 45 minutes during catheter placement.
If you are not staying overnight at the hospital, you should rest at home for the remainder of the day following the procedure. You may resume your usual activities the next day, but should avoid lifting heavy objects.
After having a tunneled catheter or subcutaneous port placed, you may experience bruising, swelling and tenderness in the chest, neck or shoulder, but these symptoms clear up in a few days. Pain medicine may help during this time.
You will receive instructions on how to care for your incision(s) and your particular vascular access device. For the first week, it is especially important to keep the catheter site clean and dry. Some, but not all, doctors will recommend sponge bathing around the catheter site, then cleaning the area with peroxide, applying an anesthetic ointment that contains an antibiotic and bandaging the area.
You may be allowed to shower after one week, using a piece of plastic wrap over the site where the catheter was inserted. You should not allow the incision to be held under water by swimming or soaking in a tub.
You may be advised to flush your catheter with a heparin solution may help keep blood clots from forming and blocking the catheter.
You should call the doctor or nurse if you have any questions about your vascular access device or if:
- The device malfunctions.
- There is bleeding at the insertion site or signs of infection.
- You develop a fever.
- You notice redness, increased swelling, tenderness, warmth or fluid drainage at the catheter insertion site.
Vascular access catheters are usually removed by a health professional. PICC and non-tunneled central catheters may be removed by nurses or technologists how an I.V. would be removed, and the site covered with a Band-aid. Tunneled catheters and port catheters will be removed by a physician. To remove these catheters, the skin is frozen with local anesthesia. An incision is required to remove the port catheter. Removal takes about 15 minutes and is done as an out-patient procedure. The skin will need to be protected from water until the incision is fully healed after removal.