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Comparison of Venous Access Methods

By March 9, 2021 No Comments

Venous access has many indications in both long and short-term settings2. While it is a common practice in both outpatient and inpatient practice, it is associated with substantial risks such as thrombosis, renal failure, and infection2. Venous access methods can be divided into peripheral and central access, and the device and type of access are chosen in accordance with the patient’s health profile and infusion needs.  

Peripheral access is becoming a more and more common, particularly in an ICU/in-patient setting. A 2000 retrospective analysis looked at the safety and efficacy of using central venous catheters with a peripheral access port in 109 patients over a four-year period1. Access in this case was through the basilar or brachial vein, and arm ports were placed by interventional radiologists1. While complications did arise, mainly infection and peripheral venous thrombosis, they were adequately treated, and there was little to no risk of central venous thrombosis via blood clot migration to the innominate or jugular veins1. This paper concluded that peripheral access via arm ports is safe and efficacious in both long and short-term patients, and that arm ports are equally as safe as chest ports for long-term use (i.e. with chemotherapy or extended-period antibiotic use)1

A more recent paper investigated nurses using peripherally inserted central catheters (PICCs) in both ICU and non-ICU patients4. PICCs have gained traction as a replacement for midline peripheral catheters due to their increased potential dwell-times and a central tip location2. Earlier papers showed that PICCs can be inserted by trained nurses, thus reducing physician workload and cutting costs, and still have a comparable safety profile and efficacy to central venous catheterization4. While this study does substantiate the claim that PICCs are a good option for patients needing a central line, it also notes limitations of PICCs (low flow, difficult central venous pressure monitoring, and radio diagnostic limitations). Furthermore, the increased incidence of infection in the ICU group showed that maintenance care is critical for good outcomes with PICCs in long-term patients4. Overall, both studies assert that peripheral venous access is safe, with distinct advantages and pitfalls when compared to central venous access4.  

Centrally inserted catheters are typically inserted into the internal jugular vein, external jugular vein, or subclavian or superior vena cava and is a staple technique for patients on chemotherapy or in need of parenteral nutrition3. It helps to avoid venous toxicity, but again there are concerns of infection and thrombosis3. An 11-year retrospective study was conducted in 2009 on the use of totally implanted central venous access ports, which found that technique to be a safe access method for long-term IV administration 3. However, there was a significant complication rate of 19%3. The most common complication was infection, with about 7.5% patients affected, followed by thrombosis, pneumothorax, tachycardia, malposition, dyspnea and other technical complications3. An important prognostic factor delineated in this study was location of catheter tip and vein of IV access, because the risk of thrombosis was significantly higher with placement in the peripheral venous system through the subclavian vein and in obese patients. Furthermore, totally implanted central venous access ports placed on the right side were associated with fewer complications3.  

Venous access is an important and routine part of medical care in many different types of settings. While both peripheral and central venous access are considered safe and effective, clinicians should make choices based on a patient-specific plan.  

References  

  1. Bodner LJ, Nosher JL, Patel KM, Siegel RL, Biswal R, Gribben CE, Tokarz R. Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients. Cardiovascular and Interventional Radiology 2000; 23: 187-193. doi:10.1007/s002700010041 
  1. Cheung E, Baerlocher MO, Asch M, Myers A. Venous access. A practical review for 2009. Official Publication of The College of Family Physicians of Canada 2009; 55(5): 494-496. PMID: 19439704 
  1. Ignatov A, Hoffman O, Smith B, Fahlke J, Peters B, Bischoff J, Costa SD. An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction. European Journal of Surgical Oncology 2009; 35(3): 241-246. doi:10.1016/j.ejso.2008.01.020 
  1. Lacostena-Perez ME, Buesa-Escar M, Gil-Alos, AM. Complications related to the insertion and maintenance of peripheral venous access central venous catheter. Sociedad Espanola de Enfermeria Intensiva y Unidades Coronarias 2019; 30(3): 116-126. doi:10.1016/j.enfi.2018.05.002