Fig. 3.1
A clinical photograph showing a peripherally inserted central catheter (PICC)
Fig. 3.2
Diagrammatic representation of a tunnelled double lumen central line. Note the proper position of the tip of the catheter in the superior vena cava
Peripheral venous cut-down
Open central venous access:
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Open central venous tunnelled catheters
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Totally implantable venous access (Port-a-cath)
Peripherally Inserted Central Catheter
The simplest, safest, and most reliable vascular access is PICC (Fig. 3.1).
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These catheters are inserted through a peripheral vein and advanced into the heart.
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They require local anaesthesia.
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They are easy to insert.
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They can be done at bedside.
Central Venous Tunnelled Catheter
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Fig. 3.3A chest X-ray showing a tunnelled central line. Note the position of the tip of the catheter at the junction of the brachiocephalic vein and the internal jugular vein -
It can be single lumen or double lumen.
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It is inserted under anaesthesia through a big vein in the neck.
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Advantage is it can be inserted in any age group.
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It can be kept for longer duration until the treatment is over.
Implantable Ports (Port-A-cath)
Implantable ports are one of the best-suited options for children (Figs. 3.4, 3.5, and 3.6). They are:
Fig. 3.4
a A photograph showing the single port. b The already connected port. There are also double ports. The length of the catheter to be used is determined intra-operatively and using fluoroscopy to determine the proper position of the catheter
Fig. 3.5
(a) A photograph showing the Huber needle used to infuse fluids and medications via the port. Ordinary needles should not be used and a chest X-ray (b) showing the Port-A-cath. Note the position of the tip of the catheter in the superior vena cava
Fig. 3.6
a and b, Two types of percutaneously inserted central lines
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