The percutaneous<unk>  is inserted directly through the skin. The subclavian (left), internal (right) or external jugular, or femoral vein is used. There are several types of<unk> s; these can be further subdivided by site (where the catheter is inserted into the body) as well as the specific type of catheter used. By site Percutaneous<unk>  <unk>  A percutaneous<unk> , or<unk> , is inserted directly through the skin. The internal or external jugular, subclavian, or femoral vein is used. It is most commonly used in critically ill patients. The<unk>  can be used for days to weeks, and the patient must remain in the hospital. It is usually held in place with sutures or a manufactured securement device. Commonly used catheters include Quinton catheters. Peripherally inserted central catheters (PICC) PICC line inserted in the upper arm (through the basilic vein) A peripherally inserted central catheter, or PICC line (pronounced "pick"), is a<unk>  inserted into a vein in the arm (via the basilic or cephalic veins) rather than a vein in the neck or chest. The basilic vein is usually a better target for cannulation than the cephalic vein because it is larger and runs a straighter course through the arm. The tip of the catheter is positioned in the superior vena cava. PICC lines are smaller in diameter than central lines since they are inserted in smaller peripheral veins, and they are much longer than<unk> s (50–70 cm vs. 15–30 cm). Therefore, the rate of fluid flow through PICC lines is considerably slower than central lines, rendering them unsuitable for rapid, large volume fluid resuscitation. PICCs can easily occlude and may not be used with dilantin IV. However, PICC lines are desirable for several reasons. They can provide<unk>  access for up to one year. The patient may go home with a PICC. They avoid the complications of central line placement (e.g. pneumothorax, accidental arterial cannulation), and they are relatively easy to place under ultrasound guidance and cause less discomfort than central lines. PICC lines may be inserted at the bedside, in a home or radiology setting. It is held in place with sutures or a manufactured securement device. Subcutaneous or tunnelled<unk>  Tunnelled<unk>  Tunneled catheters are passed under the skin from the insertion site to a separate exit site. The catheter and its attachments emerge from underneath the skin. The exit site is typically located in the chest, making the access ports less visible than catheters that protrude directly from the neck. Passing the catheter under the skin helps to prevent infection and provides stability. Insertion is a surgical procedure, in which the catheter is tunnelled subcutaneously under the skin in the chest area before it enters the SVC. Commonly used tunneled catheters include Hickman, and Groshong, or Broviac catheters and may be referred to by these names as well. A tunnelled catheter may remain inserted for months to years. These<unk> s have a low infection rate due to a Dacron cuff, an antimicrobial cuff surrounding the catheter near the entry site, which is coated in antimicrobial solution and holds the catheter in place after two to three weeks of insertion. Implanted<unk>  (ICVC, port a cath) Implanted<unk>  Implanted port Gripper needle inserted in port An implanted<unk> , also called a port a cath or port a catheter, is similar to a tunneled catheter, but is left entirely under the skin and is accessible via a port . Medicines are injected through the skin into the catheter. Some implanted ports contain a small reservoir that can be refilled in the same way. After being filled, the reservoir slowly releases the medicine into the bloodstream. Surgically implanted infusion ports are placed below the clavicle (infraclavicular fossa), with the catheter threaded into the heart (right atrium) through a large vein. Once implanted, the port is accessed via a "gripper" non-coring Huber-tipped needle (PowerLoc is one brand, common sizes are length; 19 and 20 gauge. The needle assembly includes a short length of tubing and cannula) inserted directly through the skin. The clinician and patient may elect to apply a topical anesthetic before accessing the port. Ports can be used for medications, chemotherapy, and blood sampling. As ports are located completely under the skin, they are easier to maintain and have a lower risk of infection than<unk>  or PICC catheters. An implanted port is less obtrusive than a tunneled catheter or PICC line, requires little daily care, and has less impact on the patient's day-to-day activities. Port access requires specialized equipment and training. Ports are typically used on patients requiring periodic<unk>  access over an extended course of therapy, then flushed regularly until surgically removed. If<unk>  access is required on a frequent basis over a short period, a catheter having external access is more commonly used. Catheter types Triple-lumen catheter The most commonly used catheter for central<unk>  access is the triple lumen catheter. They are preferred (particularly in the ICU) for their three infusion channels that allow for multiple therapies to be administered simultaneously. They are sized using the French scale, with the 7 French size commonly used in adults. These catheters typically have one 16 gauge channel and two 18 gauge channels. Contrary to the French scale, the larger the gauge number, the smaller the catheter diameter. Although these catheters possess one 16 gauge port, the flow is considerably slower than one would expect through a 16 gauge peripheral IV due to the longer length of the<unk>  (see section on "catheter flow" above). It is important to note that the use of multiple infusion channels does not increase the risk of catheter-related blood stream infections. Hemodialysis catheter Hemodialysis catheters are large diameter catheters (up to 16 French or 5.3mm) capable of flow rates of 200–300 ml/min, which is necessary to maintain the high flow rates of hemodialysis. There are two channels: one is used to carry the patient's blood to the dialysis machine, while the other is used to return blood back to the patient. These catheters are typically placed in the internal jugular vein. Introducer sheaths Introducer sheaths are large catheters (8–9 French) that are typically placed to facilitate the passage of temporary vascular devices such as pulmonary artery catheters. The introducer sheath is placed first, and the device is then threaded through the sheath and into the vessel. These catheters can also serve as stand-alone devices for rapid infusion given their large diameter. When paired with a pressurized infusion system, flow rates of 850 ml/min have been achieved.
Central venous catheter
Peripheral venous catheter
Arterial line
Quinton catheter
Peripherally inserted central catheter
Vascular closure device
Hickman line
Vascular access