In
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
, a peripheral venous catheter, peripheral venous line, peripheral venous access catheter, or peripheral intravenous catheter, is a
catheter
In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...
(small, flexible tube) placed into a
peripheral vein
The peripheral vascular system is the part of the circulatory system that consists of the veins and arteries not in the chest or abdomen (i.e. in the arms, hands, legs and feet). The peripheral arteries supply oxygenated blood to the body, a ...
for
venous access Venous access is any method used to access the bloodstream through the veins, either to administer intravenous therapy (e.g. medication, fluid), parenteral nutrition, to obtain blood for analysis, or to provide an access point for blood-based treat ...
to administer
intravenous therapy
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutri ...
such as medication fluids.
Use
The catheter is introduced into the vein by a needle (similar to blood drawing), which is subsequently removed while the small plastic
cannula
A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...
remains in place. The catheter is then fixed by taping it to the patient's skin or using an adhesive dressing.
A peripheral venous catheter is the most commonly used vascular access in medicine. It is given to most
emergency department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
and
surgical
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
patients, and before some
radiological
In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium. This includes:
* ''electromagnetic radiation'', such as radio waves, microwaves, infrared, visib ...
imaging techniques using
radiocontrast
Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically io ...
, for example. In the United States, in the 1990s, more than 25 million patients had a peripheral venous line each year.
A peripheral venous catheter is usually placed in a vein on the hand or arm. It should be distinguished from a
central venous catheter
A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more central ...
which is inserted in a central vein (usually in the
internal jugular vein
The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve.
It begins in the posteri ...
of the neck or the
subclavian vein
The subclavian vein is a paired large vein, one on either side of the body, that is responsible for draining blood from the upper extremities, allowing this blood to return to the heart. The left subclavian vein plays a key role in the absorption ...
of the chest), or an
arterial catheter
An arterial line (also art-line or a-line) is a thin catheter inserted into an artery.
Use
Arterial lines are most commonly used in intensive care medicine and anesthesia to monitor blood pressure directly and in real-time (rather than by i ...
which can be placed in a peripheral or central artery. In children, a topical
anaesthetic
An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia — in other words, to result in a temporary loss of sensation or awareness. They may be divided into two ...
gel (such as
lidocaine
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...
) may be applied to the insertion site to facilitate placement.
Blood sampling can be carried out at the time of insertion of a peripheral venous catheter or at a later time.
Peripheral venous catheters may also be used in the emergency treatment of a tension pneumothorax- they can be placed in the second intercostal space along the mid clavicular line in order to relieve tension before definitive management with a chest drain.
Complications
Infection,
phlebitis
Phlebitis (or Venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis and is then called thrombophlebitis or superficial thrombophlebitis. Unlike ...
,
extravasation
__NOTOC__
Extravasation is the leakage of a fluid out of its container into the surrounding area, especially blood or blood cells from vessels. In the case of inflammation, it refers to the movement of white blood cells from the capillaries to th ...
,
infiltration
Infiltration may refer to:
Science, medicine, and engineering
*Infiltration (hydrology), downward movement of water into soil
*Infiltration (HVAC), a heating, ventilation, and air conditioning term for air leakage into buildings
*Infiltration (me ...
,
air embolism,
hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
(bleeding) and formation of a
hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
(bruise) may occur. A catheter embolism may occur when a small part of the cannula breaks off and flows into the vascular system. When removing a peripheral IV cannula, the tip should be inspected to ensure it's intact.
Because of the risk of insertion-site infection the
CDC
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
advises in their guideline that the catheter needs to be replaced every 96 hours. However, the need to replace these catheters routinely is debated.
Expert management has been shown to reduce the complications of peripheral lines.
It is not clear whether any dressing or securement device is better than the other on reducing the rates of catheter failures.
Sizes
Sizes of peripheral venous catheters can be given by
Birmingham gauge
The Birmingham gauge is a wire gauge system, and is also used to specify thickness or diameter of hypodermic needles and tube products.
Terminology
Birmingham gauge is also known as the Stubs Iron Wire Gauge or Birmingham Wire Gauge. It is not t ...
or
French gauge. Diameter is proportional to French gauge and inversely proportional to Birmingham gauge.
History
The insertion of a plastic cannula and withdrawal of the needle was introduced as a technique in 1945.
The first disposable version to be marketed was the ''Angiocath'', first sold in 1964. In the 1970s and 1980s, the use of plastic cannulas became routine, and their insertion was more frequently delegated to nursing staff.
[
Newer catheters have been equipped with additional safety features to avoid ]needlestick injuries
A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick i ...
. Modern catheters consist of synthetic polymers such as teflon
Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. It is one of the best-known and widely applied PFAS. The commonly known brand name of PTFE-based composition is Teflon by Chemou ...
(hence the often used term 'Venflon' or 'Cathlon' for these venous catheters). In 1950 they consisted of polyvinyl chloride.polyurethane
Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic chemistry, organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethan ...
version was introduced.
Additional images
File:Pediatric patients receiving chemotherapy.jpg, An arm board is recommended for immobilizing the extremity for cannulation of the hand, the foot or the antecubital fossa
The cubital fossa, chelidon, or elbow pit, is the triangular area on the anterior side of the upper limb between the arm and forearm of a human or other hominid animals. It lies anteriorly to the elbow (Latin ) when in standard anatomical positi ...
in children.p. 349
in:
File:Placement of intravenous cannula 2.jpg, Just before inserting.
File:Placement of intravenous cannula 3.jpg, The catheter in between uses.
File:Safety viggo.jpg, Newer catheter with additional safety features.
References
External links
National Cancer Institute: peripheral venous catheterRecommended practices for the insertion and management of peripheral intravenous catheters
{{Intravenous therapy
Catheters