Chest X-ray showing tip of<unk>  line in the superior vena cava. Arrows provided to highlight the<unk>  line. Illustration of fully<unk> <unk>  A<unk>  is<unk>  in a peripheral vein such as the cephalic vein, basilic vein or brachial vein in the arm, and then threaded through the veins toward the heart, until the end of the catheter rests in the distal superior vena cava or cavoatrial junction. They must be<unk>  by a trained medical professional, including a physician, but also any trained medical professional such as a specially trained registered nurse. An ultrasound or chest X-ray, or the use of fluoroscopy, can be used during insertion and to confirm placement. The insertion is a sterile procedure, but does not need to be performed in a completely sterile environment like an operating room. Selection of vein and catheter A<unk>  line is an invasive medical procedure, and may require local or general anesthesia during the placement. The basilic vein is an appropriate size, but is not preferred in children due to its depth and surrounding tissue. On the other hand, the cephalic vein may be used, though in some people it will not be possible to advance the line to the desired location through the cephalic vein. The brachial vein is large enough for a<unk>  line, but is also located close to other features such as the brachial artery and plexus. Imaging is commonly used to evaluate the length and path of the potential veins before the practitioner selects the most appropriate vein. The catheter size for<unk>  lines is generally measured in French gauge, and may range from 2-6. The number of lumens may vary from one to three, allowing for concurrent administration of different medications which cannot be mixed. Catheters are also manufactured from multiple materials, including silicone and polyurethane. The insertable portion of a<unk>  varies from 25 to 60 cm in length, which is sufficient to reach the desired end position in most cases. Some catheters are designed to be trimmed to the required length before insertion whereas others are simply<unk>  to the needed depth with the excess remaining outside the body. Catheters are supplied with a guidewire. This wire is provided to stiffen the (otherwise very flexible) line so it can be more easily threaded through the veins, and is removed after insertion. Some<unk>  lines are manufactured with an antimicrobial coating intended to reduce the chance of an infection from the line, but these are not yet in widespread use. Insertion While an operating room is not required for the insertion of a<unk>  line, it is important to maintain a sterile environment surrounding the insertion site. This involves cleaning the skin around the site, as well as the use of a sterile gown, gloves, and drape to reduce the risk of environmental contamination. After the skin is prepared, an incision is made and a device called an "introducer" is<unk>  into the vein. The catheter is cut to the desired length if required, and filled with saline for the duration of the insertion. The<unk>  line is<unk>  via the introducer device, and threaded through the veins to the desired end location. Fluoroscopy or electrocardiography (ECG) guidance may be used to monitor the tip position during insertion. Removal In most cases the removal of a<unk>  is a simple procedure. Generally, the catheter line can be safely and quickly removed by a trained nurse, even in the patient's own home, in a matter of minutes. After removal, the insertion site is normally bandaged with sterile gauze and kept dry for a few days, during which the wound can close and begin healing. Usually, a smaller adhesive bandage can be placed over the wound site after the gauze is removed if the wound is slow to heal. The tip of the catheter is sent for microscopy culture and sensitivity (MCS) if the patient is systemically unwell at the time of removal of the<unk> . In certain units, it is sent as routine investigation.
Peripherally inserted central catheter
Central venous catheter
Peripheral venous catheter
Vascular access for chemotherapy
Quinton catheter
Vascular closure device
Vascular access
Arterial line