Venous Access | The Massachusetts General Hospital Handbook of Neurology

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

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

> 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.