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The preferred site of insertion (including for non-tunneled catheter placement), from an infection prevention point of view, is in the subclavian vein, and to generally avoid the femoral vein if possible. There is no clear recommendation for a tunneled catheter site in the guidelines.
Groshongs may be left in place for extended periods and are used when long-term intravenous therapy is needed, such as for chemotherapy.Similar to the Hickman line, the tip of the catheter is in the superior vena cava, and the catheter is tunneled under the skin to an incision on the chest wall, where the distal end of the catheter exits the body.
Most common complications with venous access are catheter related infections, thrombophlebitis and venous thrombosis. If having thrombophlebitis or thrombosis; pain when using the access is another complication. Peripheral venous access is least prone to thrombosis, followed by midline catheters and the centrally placed catheters.
A Hickman line two-lumen catheter inserted on the patient's left side. Scars at the base of the neck indicate the venotomy site and insertion point into the left jugular vein . A Hickman line is a central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis.
Catheter placement. Central venous catheter placement: Vascular access and management of intravenous devices (IVs), including both tunneled and non-tunneled catheters (e.g., PIC, Hickman, port catheters, hemodialysis catheters, translumbar and transhepatic venous lines).
The catheter is inserted into the vessel under ultrasound or fluoroscopic guidance and tunneled through the skin. Tunneled catheters have multiple channels called lumens which lay exposed on the surface of the skin. These lumens are the access points when the catheter is used. Tunneled catheters can be single, double, or triple lumened.
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