Vascular Access Devices


clothing. Regardless of the type of catheter utilized, correct catheter tip placement (at the cavoatrial junction or distal SVC) in patients receiving HPN is essential to reduce the risk of catheter malfunction and catheter- related thrombosis.11


Peripheral Vascular Access Devices


Peripheral catheters are usually placed at the bedside by a nurse and carry a lower risk of complications compared to central catheters.4


the most common complication and is characterized by pain, swelling, and redness at the insertion site.12


Phlebitis is Thrombophlebitis is inflammation


of the vein with formation of a thrombus (blood clot). In most cases, phlebitis and thrombophlebitis are caused by infusion of hyperosmolar solutions. Both phlebitis and thrombophlebitis require that the catheter be removed and replaced at a different site. Treatment of phlebitis may include application of heat and elevation of the affected limb to reduce associated inflammation.1 Another serious complication of peripheral catheters is extravasation,


or damage to body tissue caused by leaking of an IV solution into nearby tissue.1


Extravasation can lead to significant tissue damage, potentially


requiring surgical treatment. Therefore, it is necessary to closely monitor IV sites when administering peripheral PN, particularly in patients who are not able to recognize signs and symptoms of complications related to the IV site. Signs and symptoms of extravasation include skin blanch- ing, swelling, and formation of blisters at the site.13,14


Treatment includes


prompt removal of the IV catheter, possible hot/cold application, admin- istration of drug-specific antidotes, and/or irrigation or other procedures, depending on the leaked solution and extent of extravasation.1,14


Midline Catheters


Midline catheters are extended-dwell peripheral catheters. Midlines are the longest peripheral VADs (between 15 and 25 cm in length) and extend as far as the axillary vein without entering the subclavian vein.15 Because of the risk of upper-extremity thrombosis and phlebitis, mid- line catheters are not recommended for administration of central PN or HPN solutions.16


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