VASCULAR ACCESS
A vascular access procedure involves the insertion of a flexible and sterile thin plastic tube, or catheter, into a blood vessel.
What are Vascular Access Procedures?
A vascular access procedure involves the insertion of a flexible, sterile small plastic tube, or catheter, into a blood vessel to provide an effective method of drawing blood or delivering medications and nutrients into the bloodstream over a prolonged period This prevents the need for multiple canulas each time a blood test or treatment is required.
A simple intravenous (IV) line is effective for short-term use, but is not suitable for long-term use. When an IV line is necessary for a longer period of time, a special catheter called a tunnelled central venous catheter can be used. Because the catheter is tunnelled under the skin it can remain in place for months to years. and be repeatedly accessed. Tunnelled central venous catheters essentially fall into 2 groups Tunnleled central venous lines (Hickman, Groshong, Broviac, Leonard or diaysis lines) where the line exits on the chest or implantable Ports (Portacaths) where the device is completely buried and requires needle access into a chamber.
Vascular access procedures are performed when patients need:
The commonest indication is for the delivery of cancer treatments and dialysis. A significant number of treatments for cancer now involve intravenous chemotherapy either before / after surgery or as a primary treatment. Each visit requires a blood test and an intravenous canula (needle) to administer the drugs. This damages the veins and can make it very difficult and painful to find suitable veins. Tunnelled central venous catheters avoid all this and give a neat easy way to have your treatment and blood tests. Other treatments where tunneled central venous catheters can help is for medications (when a patient is not able to safely swallow needed medication either for a short or long period), long-term intravenous (IV) feeding for nutritional support, long term intravenous antibiotics and haemodialysis.
What happens during the procedure?
The procedure is performed with image guidance. Both ultrasound and X-rays are used to allow accurate insertion and placement of the tunnelled central venous line or Port. To relax you, the procedure is performed with intravenous sedation; there is no need for a general anaesthetic and the related risks. The procedure is performed under sterile conditions, your skin will be prepped with antiseptic fluid and you will be covered with sterile drapes, this will cover your face but the nurses will create a small tunnel. Local anaesthetic is then injected at the line insertion site, this may sting for a few seconds but then it will go numb. The vein in the neck is accessed with ultrasound guidance and the line is placed into the central vein, and after a further injection of local anaesthetic on the chest either the line exits onto the chest or a small Port pocket is fashioned through a small 5-6cm incision. The Port is then placed under the skin and sutured. The majority of patients do not remember the procedure, due to the use of sedation to help you relax. When you leave the interventional radiology suite the line or Port will be fully functioning and ready for use.
How should I prepare?
The procedure is performed as a day case. You will be asked to remain nil by mouth for 4 hrs prior to the procedure. You will be admitted to the suite by the nursing staff and may have a few routine blood tests. You may be asked to talk a special shower to reduce the chances of infection.
Following the procedure you will be taken back to your room where you will be looked after by nursing staff. You will be a little sore for a couple of days along the tunnel portion, Port site and neck, you may have a small bruise. You will feel drowsy for about an hour, during which you may need oxygen. After an hour or when you feel fit you can eat and drink. Once the nursing staff is happy you will be able to go home.
