Central Venous Access Catheters

A central venous access catheter is a long-term IV that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. When you have a central venous access catheter, you are spared the irritation and discomfort of repeated needlesticks. In interventional radiology, placement of a central venous catheter can usually be performed with moderate sedation and local anesthetic. Approximately 5 million central venous access catheters are placed each year, and doctors are increasingly recommending their use.

There are several types of central venous access catheters:

• Tunneled small-bore catheters, which are often referred to as Hohn, Hickman, or Broviac catheters, are frequently used for infusion of antibiotics or other medications, nutritional supplements, and chemotherapy treatments. Depending on the expected duration of use (usually months), these catheters may have retention cuffs to reduce infection risk and prevent accidental removal, or they may simply have an antibiotic-impregnated cuff, which reduces infection risk but allows for easy catheter removal. Some of our tunneled small-bore catheters can be used with a power injector for a CT scan or MRI, avoiding a separate intravenous catheter placement.
• Peripherally inserted central catheters (also called PICC lines) are placed in the veins of the upper arms. They are easily removed and are used when venous access is required for weeks up to a few months. Some of our PICC lines can also be used with a power injector for a CT scan or MRI.
• Tunneled dual-lumen catheters are placed in patients requiring stem cell transplant or for other indications that require larger flow volumes than can be provided by a small-bore catheter.
• Tunneled dialysis catheters are placed in patients who require hemodialysis. These catheters are specially designed for rapid flow of blood to and from the dialysis machine. These are most frequently placed in the veins of the neck, although other sites can be used if necessary. Tunneled dialysis catheters are placed in patients who require hemodialysis but do not have a functioning fistula or graft. If a previously functional hemodialysis fistula or graft is experiencing poor flows or thromboses, interventional radiologists can also use procedures such as angioplasty, stent placement, and thrombolytic therapy to salvage function.
• Implantable ports are most frequently used for cancer chemotherapy or for patients with diseases, such as cystic fibrosis, for which there will be a long-term need for frequent venous access. These ports can be maintained for longer periods (months to years). They are placed and removed by a small surgical incision and lie entirely under the skin. They are accessed with a special needle. These are available with a single lumen (most commonly used) or two lumens. Most of the ports we implant can be used with a power injector for a CT scan or MRI.

Which patients require central venous access catheters?

Doctors often recommend CVACs for patients who regularly undergo:

• Chemotherapy treatments
• Infusions of antibiotics or other medications
• Nutritional supplement infusions
• Hemodialysis

When and how are central venous access catheters removed?

When the central venous access catheter is no longer necessary, or if a catheter-related infection arises, interventional radiologists can assist in removing the catheter. Certain catheters—such as PICC lines and Hohn catheters—can be easily removed at the bedside or in clinic. Other catheters may require dissection of the cuff from the subcutaneous tissues, which requires sterile technique, local anesthetic and possibly sedation. Port catheters require a small incision for removal.