ULTRASOUND-GUIDED CENTRAL VASCULAR
ACCESS: TECHNIQUES, DEVICES, AND
COMPLICATIONS
What is the primary role of central venous access?
To provide care for critically ill patients.
List some uses of central venous access.
Intravenous antibiotic therapy, central venous pressure monitoring, hemodialysis, chemotherapy,
total parenteral nutrition.
What are central vascular access devices (VAD)?
Catheters placed so the terminal tip resides in a central vein, most often the superior vena cava.
What factors determine the type of VAD used?
Patient characteristics, therapy duration, number of infusions, and type of infusions.
Name the most common target veins for central VADs.
Basilic, brachial, cephalic, subclavian, and internal jugular veins.
Where does the catheter tip typically reside in a central VAD?
At the atriocaval junction in the superior vena cava.
What are nontunneled central vascular access devices?
VADs placed percutaneously into a central or peripheral vein, with the device tip at the
atriocaval junction.
What types of devices are included in nontunneled central VADs?
Critical care catheters, temporary dialysis and apheresis catheters, small-bore polyurethane
catheters, and peripherally inserted central catheters (PICCs).
How are nontunneled central VADs secured?
With sutures or adhesive securement devices.
What are tunneled central vascular access devices?
Devices where the catheter is tunneled under the skin to the puncture site, with the tip at the
atriocaval junction.
What is the advantage of tunneled VADs?
They are more comfortable for the patient and reduce the risk of device-related infection.
, What are implanted ports in the context of VADs?
VADs with a catheter segment attached to a reservoir placed under the skin, accessed with a
noncoring needle.
When are implanted ports typically used?
For patients requiring intermittent therapy, such as weekly or monthly treatments.
What is the preferred vein for peripheral VAD placement?
The basilic vein due to its high volume flow.
What veins may be used for peripheral VAD placement in neonates and children?
Lower extremity veins, such as saphenous veins.
What is the most common site for central VAD placement?
Internal jugular veins and subclavian veins.
What is the typical blood flow of the cephalic vein?
Approximately 30 mL/min.
What is the significance of the atriocaval junction in VAD placement?
It is where the catheter tip resides for optimal function.
What is the primary purpose of ultrasound in peripheral VAD placement?
To guide the placement of catheters.
What are the potential complications of central venous access?
Infection, thrombosis, and mechanical complications.
What is the role of ultrasound in assessing veins for VAD placement?
To visualize and evaluate the anatomy before catheter insertion.
What is the typical duration of use for nontunneled central VADs?
Days to weeks.
How does the tunneling of a catheter benefit the patient?
It provides stability and reduces the risk of infection.
What is the function of the silicone septum in implanted ports?
It allows access with a noncoring needle for medication delivery.
What are the common sites for Central VAD placement?
Internal jugular veins and subclavian veins.
ACCESS: TECHNIQUES, DEVICES, AND
COMPLICATIONS
What is the primary role of central venous access?
To provide care for critically ill patients.
List some uses of central venous access.
Intravenous antibiotic therapy, central venous pressure monitoring, hemodialysis, chemotherapy,
total parenteral nutrition.
What are central vascular access devices (VAD)?
Catheters placed so the terminal tip resides in a central vein, most often the superior vena cava.
What factors determine the type of VAD used?
Patient characteristics, therapy duration, number of infusions, and type of infusions.
Name the most common target veins for central VADs.
Basilic, brachial, cephalic, subclavian, and internal jugular veins.
Where does the catheter tip typically reside in a central VAD?
At the atriocaval junction in the superior vena cava.
What are nontunneled central vascular access devices?
VADs placed percutaneously into a central or peripheral vein, with the device tip at the
atriocaval junction.
What types of devices are included in nontunneled central VADs?
Critical care catheters, temporary dialysis and apheresis catheters, small-bore polyurethane
catheters, and peripherally inserted central catheters (PICCs).
How are nontunneled central VADs secured?
With sutures or adhesive securement devices.
What are tunneled central vascular access devices?
Devices where the catheter is tunneled under the skin to the puncture site, with the tip at the
atriocaval junction.
What is the advantage of tunneled VADs?
They are more comfortable for the patient and reduce the risk of device-related infection.
, What are implanted ports in the context of VADs?
VADs with a catheter segment attached to a reservoir placed under the skin, accessed with a
noncoring needle.
When are implanted ports typically used?
For patients requiring intermittent therapy, such as weekly or monthly treatments.
What is the preferred vein for peripheral VAD placement?
The basilic vein due to its high volume flow.
What veins may be used for peripheral VAD placement in neonates and children?
Lower extremity veins, such as saphenous veins.
What is the most common site for central VAD placement?
Internal jugular veins and subclavian veins.
What is the typical blood flow of the cephalic vein?
Approximately 30 mL/min.
What is the significance of the atriocaval junction in VAD placement?
It is where the catheter tip resides for optimal function.
What is the primary purpose of ultrasound in peripheral VAD placement?
To guide the placement of catheters.
What are the potential complications of central venous access?
Infection, thrombosis, and mechanical complications.
What is the role of ultrasound in assessing veins for VAD placement?
To visualize and evaluate the anatomy before catheter insertion.
What is the typical duration of use for nontunneled central VADs?
Days to weeks.
How does the tunneling of a catheter benefit the patient?
It provides stability and reduces the risk of infection.
What is the function of the silicone septum in implanted ports?
It allows access with a noncoring needle for medication delivery.
What are the common sites for Central VAD placement?
Internal jugular veins and subclavian veins.
