The Massachusetts General Hospital Handbook of Neurology

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Procedures > Venous Access

Venous Access

A. Peripheral IVs

• Need: Gloves, chuck, gauze, iodine/alcohol prep, lidocaine, tourniquet, angiocatheter, extension set or plug, saline flushes in 3-cc syringes, Tegaderm, tape.

• Placement: Try for the forearm; antecubital IVs pinch off when the pt. moves his arm. In pts. with poor arm veins, consider the feet and, occasionally, external jugular.

B. Percutaneously inserted central catheters (PICC lines)

• Indications: For pt. who will need an IV more than 7 days or who needs central delivery of drug. Especially good for home IV therapy. You should not draw blood samples off them.

• Placement: Often done by specially trained PICC nurse. Difficult ones may be done fluoroscopically.

C. Central venous neck lines (IJ, SC)

• Indication: Urgent central delivery of drugs, e.g., pressors, Nipride, nitroglycerine >400 g/min; or frequent blood draws. Consider PICC as nonemergent alternative.

• Placement: See Central Venous Line, p. 223.

P.227

D. Quinton catheters

For dialysis, pheresis. Usually inserted by surgeons.

E. Hickman catheters

Surgically placed semi long-term (e.g., several months) central access, e.g., for chemotherapy. External ports on chest.

F. Portacaths

Surgically placed long-term (e.g., years) central access, e.g., for chemotherapy. Has subcutaneous ports in chest.

G. Clogged catheters

Try urokinase: slowly instill 5,000 units.