Infusion peripherally inserted central catheters

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

MidUne catheters and peripherally inserted central catheters (PlCC) are inserted in a peripheral vein but the tip rests in a larger vein. The infusion fluid flows directly in the larger vein which diminishes the chance of phlebitis. Both types of catheters are typically inserted in a vein in the upper arm. The midline catheter ends at armpit height the tip of the PICC rests in the vena cava superior. The PlCC may have single or multiple lumens. The PlCC line can be used as a central venous catheter for infusion which needs fast dilution or distribution or both such as antibiotics, pain medicine, chemotherapy, nutrition, etc. 

In patients with CKD, preservation of the integrity of peripheral and central veins is of vital importance for future hemodialysis access. Avoid i.v. infusion or vein puncture in the forearm and upper arm veins at both arms whenever possible. Insertion of venous access devices carries the risk to injure the veins and thereby incite phlebitis, sclerosis, stenosis or thrombosis and has to be avoided. Whenever a central venous catheter is needed, catheterization of the internal jugular or femoral vein is always preferred. Use of subclavian vein should be... 

The incidence and duration of phlebitis seems to be dependent on a variety of factors. Physical-chemical factors such as low pH, hypertonicity, particles and precipitation play a role in the cause. Active substances that are poorly soluble in water may precipitate and can cause acute phlebitis. Active substances with adequate aqueous solubility may tend to cause phlebitis only because of prolonged or chronic administration. Clinical factors involving injection technique (infiltration, extravasation, type of needle, duration of infusion) but also irritating characteristics of the active substance can contribute to the occurrence of phlebitis [9, 10]. Sometimes (septic) phlebitis is caused by bacterial infection (e.g. cause of inappropriate aseptic technique during catheter insertion) and is characterised by inflammation with suppuration of the vein wall. Local responses to the parenteral challenges can be diminished by dilution of the medicine or by central venous instead of peripheral venous administration (see Sect. 13.10.3). 

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