6.15 Long Term Venous Access

Question 1

a) What are the main indications for long-term venous access?

Answer 1

● Dialysis.

● Parenteral nutrition.

● Cancer therapy.

● Long-term antibiotic therapy.

Question 2

b) What are the common types of long-term venous catheters?

Answer 2

● Peripherally inserted central catheters (PICC).

● Midline catheters.

● Tunnelled cuffed catheters, e.g. Hickman.

● Port catheters.

● Dialysis catheters, e.g. Permcath™.

Question 3

c) What are the main considerations for choosing the insertion
site for long-term venous access?

Answer 3

● Coagulopathy.

● Poor limb or vein condition.

● Musculoskeletal abnormalities.

● Comfortable site for long-term catheter.

● Cosmetic condition.

● Ease of maintenance of cleanliness.

Question 4

d) What is the ideal site for catheter tip position?

Answer 4

● Long axis of the superior vena cava.

● Upper right atrium outside the pericardial reflection.

Question 5

e) What are the complications of long-term venous catheters?

Answer 5

Scarring
Adherent to tissue by granulation
Infection - source of sepsis
risk of bleeding if unclamped
stenosis of atria
migration
clot formation on catheter