VASCULAR ACCESS
Vascular Access

A vascular access is a procedure wherein a thin tube is inserted in a vein in the arm, in the neck or in the chest just beneath the collarbone.

The tube is then threaded into a major vein in the middle of the chest. In many conditions, having this type of tube inserted provides a simple and painless means of drawing blood, or delivering drugs, nutrients or both. This also spares the patient the discomfort and stress of repeated needle sticks. These so-called central catheters can remain in place for weeks, months or even years.

In addition, there are various types of catheters or devices that can be used in this procedure.

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During the Procedure

This may be performed in the ward, in the Radiology department or in the operating theatre. When performed in Radiology department:

  • You may be given a sedation which will help you to relax. However, you will remain awake.
  • After the appropriate arc is swabbed with a disinfectant and covered with sterile drapes, the painkiller is injected to numb the venous puncture site.
  • Using ultrasound or fluoroscopy to identify the vein, the radiologist passes a small needle into the subclavian vein, neck vein or arm vein. Through this, a small, thin wire called a guidewire is passed into the blood vessel. The catheter itself is placed over the guidewire, which is then removed.
  • For a tunnelled catheter, the radiologist will make two incisions usually smaller than one inch long: one over the vein where the catheter is inserted and the other where the catheter emerges from the skin. The catheter is placed beneath the skin between the two incisions. Finally, the radiologist will place two small stitches, one at each end of the tunnel, which will remain in place for about one to two weeks and help keep the catheter firmly in place. A small bandage is placed over the sites.
  • Implanting a port also requires two incisions (except in the arm where a single incision may suffice). The port reservoir is placed under the skin close to the lower incision. The incision for the port is a little longer than for the catheter, usually about two inches long. A small, elevated area remains on the body at the site of the reservoir; you will be able to feel it. Stitches, surgical glue or a special tape then holds the incisions together.
After the Procedure
  • Rest for the remainder of the day
  • Resume usual activities the next day but avoid carrying heavy objects
  • After having a tunnelled catheter or subcutaneous port placed, you should expect some bruising, swelling and tenderness in the chest, neck or shoulder, but these symptoms resolve over about five days. You may be prescribed some painkillers.
  • For the first week, it is especially important to keep catheter site clean and dry.
  • Please notify the doctor if problems start to develop with your catheter. Problems calling for medical attention include malfunction of the device, bleeding at the insertion site or signs of infection. Infection may be present if you develop fever or notice redness, increased swelling or tenderness, and warmth.
Benefits and Risks

BENEFITS

  • The vascular access device is an extremely useful solution for patients who, for any reason, require repeated entry into the venous circulation over a long period.
  • Patients will not need to have an IV line placed for each treatment, and their arm veins will not become badly scarred.
  • A PICC is very helpful when medicines or fluids that are irritating to the wall of the vein are administered e.g. antibiotics and blood products. It may also be used for IV feeding and frequent blood sampling.
  • A vascular access device will continue functioning well for a year or longer. The devices are easily removed when no longer needed.
  • Sometimes, a catheter, is the only way of getting access to the circulatory system for haemodialysis in patients with serious kidney disease.

RISKS

Two types of risks are associated with vascular access devices:

  • During or shortly after placement.
  • Delayed risks that occur simply because the device is in your body.

IMMEDIATE RISKS

  • Bleeding – The risk can be minimised through an advance blood test to ensure that your blood clots normally.
  • Infection – An infection may develop at an incision site shortly after catheter placement.
  • Pneumothorax – Very rarely, a patient may develop a condition called a pneumothorax, a collection of air in the chest that may cause one of the lungs to collapse.
  • Abnormal heart rhythm – The normal heart rhythm may be disturbed while the catheter is inserted, but this is usually only temporary. The problem is easily recognised during the procedure and is eliminated by adjusting the catheter position.
  • Arterial puncture – Rarely, the catheter will enter an artery rather than a vein. If this happens, the catheter will have to be removed. Most often, the artery then heals by itself, but occasionally has to be surgically repaired.

DELAYED RISKS

  • Delayed infection – Two types of delayed infection may develop: skin infection at the catheter or port insertion site, or bloodstream infection. Infections are least common after placing a port. The risk of delayed infection can be minimised if you and anyone else who will be handling the device wash hands before flushing it or cleaning the insertion site.
  • Catheter fracture – A hole or break in the catheter may lead to leakage of fluid. This problem may be seen with use of a PICC or tunnelled catheter. Breaks may be avoided by not always clamping the catheter in the same spot and by never using too much force when flushing it.
  • Accidental dislodgement of the catheter – This may occur with any catheter. If this happens, you should apply pressure to the incision site using a sterile dressing and call your physician immediately.
  • Air in the catheter – As an emergency that may cause chest pain or shortness of breath, this problem can be avoided by regularly clamping the catheter before and after inserting a syringe. It can also be avoided by making sure that the catheter cap is screwed on tightly. Call your physician immediately if this happens.
  • Catheter occlusion – Any type of vascular access catheter may become obstructed by clotted blood. You can minimise the risk by carefully following instructions about flushing the catheter. Once a catheter occludes, it sometimes can be cleared by injecting medication, but at other times must be removed or exchanged for a new catheter.
  • Vein occlusion – If the vein with the catheter becomes occluded, the arm, shoulder, neck or head may develop swelling. Call your physician immediately if this occurs. The clot may be treated by a blood thinning medication, but occasionally will have to be removed.
Vascular Access is available at:

Radiology Department,
Gleneagles Hospital

6A Napier Road, Singapore 258500
(65) 6470 5730
Fax: (65) 6470 5749

Department of Radiology & Nuclear Medicine
Mount Elizabeth Novena Hospital

38 Irrawady Road, Level 2,
Singapore 329563
(65) 6933 1188
Fax: (65) 6933 0526

Radiology Department,
Mount Elizabeth Novena Hospital

3 Mount Elizabeth, Level 2
Singapore 228510
(65) 6731 2100
Fax: (65) 6731 3368

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