Which type of vascular access device has the lowest risk of catheter-related thrombosis

Short-term CVADs are devices in situ for a minimum period of days and possibly longer if tunnelled. They are reviewed daily for continued need and removed as soon as they are no longer required.rr

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Which type of vascular access has the lowest risk of catheter related thrombosis?
What are the 3 main types of vascular access devices?
Which is safer PICC line or port?
What is catheter related thrombosis?

Advantagesr

Disadvantagesr

may be used for variety of purposes: administration of high volume, irritative, multiple incompatible solutions and medications, central venous pressure monitoring, blood sampling
may be inserted for emergent insertions
available in heparin or antimicrobial impregnated materials to reduce the risk of infection and thrombosis
relatively easy to insert and remove if not tunnelled
tunnelled – potential to reduce the risk of infection and dislodgementrr
can be inserted bedside

short-term use
can be associated with a higher risk of infections compared to other CVADs
require weekly dressings

Centrally inserted central venous catheters (CICCs) or central venous catheters (CVCs)

Centrally inserted central catheters (CICCs) or central venous catheters (CVCs) are short-term devices inserted via the veins in the neck or chest including the jugular, subclavian, or axillary veins.

Features of these catheters include:

single or multiple lumens allowing for the administration of multiple, high volume or concurrent incompatible solutions or medications
non-tunnelled so the catheter enters the vein near the skin puncture site or tunnelled catheter where the skin exit site is a distance from the venepuncture for optimal dressing and securement application
coated, bonded or impregnated with heparin, antimicrobials, silver, antiseptic

CICC/CVC- with chlorhexidine (CHG) disc, subcutaneous and adhesive external securement device (ESD) and bordered semipermeable dressing	Tunnelled CICC/CVC- with CHG disc, subcutaneous and adhesive ESD and bordered semipermeable dressing

© E. Alexandrou 2020	© E. Alexandrou 2020

Femorally inserted central catheters (FICCs)

Femorally inserted central catheters (FICCs) are short-term CICCs/CVCs inserted via the femoral vein. The catheter tip is located in the inferior vena cava.r

These catheters can have single or multiple lumens, and are non-tunnelled or tunnelled for optimal dressing and securement application.

The femoral veins should be avoided for planned insertions due to the risk of infection and thrombosis.rrrr

Tunnelled FICC – exit site tunnelled to mid thigh, with CHG disc, subcutaneous and adhesive ESD, and bordered semipermeable dressing

Apheresis catheters

Apheresis catheters are open, large bore catheters (10-18.5 Fr for adults and 6-8 Fr for paediatric patients) that tolerate high flow rates for: therapeutic procedures for treatment of chronic conditions, e.g. plasmapheresis, erythropheresis, photopheresis; and cellular collections (to produce a product), e.g. stem cells, lymphocytes, granulocytes.r

These catheters can have a single, double or triple lumen – the third lumen has a smaller diameter to allow for administration of medications or fluids.

Advantagesr	Disadvantagesr
large bore permits reliable high blood flow rates longer dwell time if tunnelled cuffed catheter can be inserted at the bedside	short-term use for non-tunnelled catheter requires different locking solutions, specific volumes/concentrations made of rigid material- may impact patient comfort and securement may be challenging require weekly dressings and locking impact on body image patient discomfort

Apheresis catheter – triple lumen, low internal jugular approach with CHG disc, subcutaneous and adhesive ESD, bordered transparent dressing

Apheresis catheter – low internal jugular approach with CHG disc, adhesive ESD and bordered semipermeable dressing

The International Society of Thrombosis and Haemostasis guidelines recommend that where possible, CVCs should be inserted on the right side, in the jugular vein with the tip located at the junction of the superior vena cava and the right atrium to minimise the risk of thrombosis.

What are the 3 main types of vascular access devices?

Vascular Access Device (VAD): Any device utilized for venous access regardless of location. These include peripheral intravenous catheter (PIV), peripherally inserted central catheter (PICC), centrally inserted central catheter (CICC), and implanted venous port.

Which is safer PICC line or port?

Since port placements require sedation and/or anesthesia in an operating room, some patients have concerns about having surgery. But other central lines can be placed in the clinic using local anesthesia. So, if you want to avoid general anesthesia, we typically recommend a PICC line.

the term catheter-related thrombosis typically refers to deep vein thrombi in the vein in which catheter is placed ¹^,⁵. most cases occur in the upper extremity where the majority of catheters are placed ⁵. accounts for 70%-80% of all upper extremity thromboses and about 10% of all venous thromboembolism ⁵^,⁶.