Intravenous therapy provides fluids and medications to millions of patients a year in home health and hospital settings, according to Carol Taylor, R.N., Ph.D., author of "Fundamentals of Nursing." Health care providers obtain intravenous access by inserting needles and flexible tubing, called catheters, into the patient's vein and attaching them to a bottle or plastic bag of sterile fluid. Health care providers select the type of catheter best suited to the patient's condition and the fluid to be administered.
Central Venous Catheter
A central venous catheter enters the vena cava, the vein that returns blood from other parts of the body to the heart. Central lines provide long-term venous access and allow infusion of potentially caustic fluids. Health care providers may choose among four catheter designs--non-tunneled, tunneled, implanted ports and PICCs or peripherally inserted central catheters--for central venous access, according to Lynda S. Hook, R.N., in an article published in September 2007 issue of "Home Healthcare Nurse." The choice of catheter depends on the type of fluid to be administered, the patient's health status and the expected duration of intravenous therapy.
Short Peripheral Catheter
Peripheral catheters provide into any vein other than the vena cava. Short peripheral catheters, no longer than three inches, include winged steel needles, often called butterflies, and over-the-needle catheters, according to Hook. Health care providers usually choose the metacarpal, cephalic, and basilic veins in the arms, if available. Alternate sites for short peripheral catheters include the feet or, for infants, the scalp. These catheters provide short-term access, up to 72 hours, and are suitable for antibiotic therapy.
Midline Peripheral Catheter
Midline peripheral catheters, 3 to 10 inches long, provide venous access from the cephalic or basilic veins in the inside of the elbow with the tips ending short of the armpit or axilla, says Hook. These catheters cause less irritation than the shorter catheters but certain medications such as vancomycin and nafcillin cannot be infused through a midline peripheral catheter. These catheters may be left in place up to 49 days, according to Taylor.
Midclavicular Peripheral Catheter
Midclavicular catheters, long catheters inserted into the medical cubital or basilic veins in the upper arm, extend into the midpoint of the clavicle, according to Hook. Although some health care providers continue to use these catheters, the devices promote clot formation and have been implicated in several deaths, so their use is controversial.
References
- "McGraw-Hill's I.V. Drug Handbook:" Patricia D. Shull, M.S.N., R.N.; 2008
- "Fundamentals of Nursing;" Carol Taylor, R.N., Ph.D.; 2008
- "Home Healthcare Nurse:" Choosing the Right Intravenous Catheter
