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Venous Access for PN

Vascular Access Devices

• Selection factors
– Length of therapy
– Type of therapy
– Available patient anatomy
– Osmolarity of solution
– Patient preference
– Patient activity and lifestyle
– Consideration of coexisting devices
Orr M, Nutr Clin Pract 1999;14:172; Sands M. J Parent Ent Nutr 2006:10:S57

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PN Venous Access

• Peripheral Access
– Basilic,
Basilic cephalic veins
eins
– Requires PN osmolarity  900 mOsm
– Requires site placement change
– Poor access sites common
• Central Access
– Temporary
• Subclavian or internal jugular most frequent
• Femoral site

PN Venous Access
• Central access
– Permanent
• Tunneled
• Sub cutaneous ports
• Peripherally inserted central catheters (PICC)
• Catheter care
– Care protocols essential for successful
outcomes
• Hand hygiene
• Skin antisepsis
• Site care and dressing regimens

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Vascular Access Devices

Catheter Types

American Society of Parenteral and Enteral Nutrition.  The A.S.P.E.N. nutrition support core curriculum: a case‐based approach –
the adult patient.  Ed. MM Gottschlich.  ASPEN, Spring Field, MD:2007.
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Catheter Types

American Society of Parenteral and Enteral Nutrition.  The A.S.P.E.N. nutrition support core curriculum: a case‐based approach – the adult 
patient.  Ed. MM Gottschlich.  ASPEN, Spring Field, MD:2007.

Types of VADs – Peripherally

inserted central catheter (PICC)

http://www.innovativenursing.org/PICC_Team.htm

http://www.fmh.org/body.cfm?id=559

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Types of VADs – Broviac/Hickman

http://uwmedicine.washington.edu/Patient‐Care/eHealth‐
Articles/PublishingImages/VascAccess_Hickman_catheter.jpg
http://emsstaff.buncombecounty.org/inhousetraining/broviac/img/lumen.gif

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Hickman / Broviac Catheter

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Types of VADs - Port

http://www.uchealth.com.au/healthwise/images/stories/poc%20port%20a%20cath.jpg

http://images.ddccdn.com/cg/images/en135134.jpg

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Indwelling Port

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Catheter vs Port
Characteristic Tunneled external catheters Subcutaneous implanted ports

Lumen Single, double, triple Single, dual

Maintenance Daily, requires patient training Monthly, no training required

Activity Some restrictions (swimming) No restrictions

Blood draw Very reliable Moderately reliable

Cost Higher maintenance cost Higher initial cost

Access External Percutaneous Huber needle

Flow Determined by lumen diameter Determined by needle gauge

Complication rate Higher Lower

Removal In the office or at the bedside May require second surgical procedure

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Complications

Infusion Phlebitis Infiltration

Extravasation

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Checking CVL Placement

Cavo‐Atrial Junction
SVC

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Checking CVL Placement

PICC in SVC

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Checking CVL Placement

Pneumothorax

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Differences in Neonates
• Central access can also include
– Umbilical vein
– Umbilical artery
• Special rules
– Either can be used for nutrition
• Keep artery more at peripheral levels
– If classified as “low-lying,”
low lying, do not use
– No lipids in umbilical artery
– Be cautious of labs if drawn through same line as
PN

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Fetal Circulation

http://nursingcrib.com/nursing‐notes‐reviewer/fetal‐circulation

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Fetal Circulation

http://easypediatrics.com/umbilical‐vein‐catheterization

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Differences in Neonates
• Often put heparin in all central lines
– 0.25 unit/mL – 2 unit/mL
• Except higher osmolarities peripherally
– Typically between 1000-1200 mOsm/L is okay
• Some institutions will run PN through both
lines
– Be careful about ordering totals for these
situations

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