PORPHRIA FACTS: IV ACCESS

There are many types of iv accesses for infusion therapy in porphyria.
Nobody wants to have a central catheter put in their body, but if your health care provider determines that you need one, knowing which catheter best fits your medical and personal needs will help you to adjust to the new catheter in your daily routine.
PERIPHERAL VENOUS ACCESS LINES

Peripheral Venous Access lines are the typical "hospital IV" line put in your hand or forearm when you are admitted to the hospital. It is a short catheter, usually 3/4 to 1 inch long, inserted into a small peripheral vein and designed to be temporary.
These catheters need to be changed every three days, or more often if they dislodge from the vein.
Because the veins used are small and have less blood flowing past the catheter, many medications can irritate a peripheral vein.
There is a plastic dressing over the catheter, which has to be kept clean and dry at all times.
These peripheral IV lines work well in the hospital, where there are nurses to monitor and change them frequently, but are impractical for extended home use because of the potential for dislodging the small catheter from the vein.
You have to be careful when moving your arm and daily activities become a little more difficult.
You have to be careful when moving your arm and daily activities become a little more difficult.
You have to be careful when moving your arm and daily activities become a little more difficult.
Blood cannot be drawn for lab tests from a peripheral catheter.
A peripheral catheter needs to be flushed with a saline and heparin injection after every use or at least twice daily if not in use.
Saline is a salt solution used to clean or "flush out" the catheter and heparin is flushed into the catheter to prevent blood from clotting in it between uses.

MIDLINE PERIPHERAL CATHETER

Midline Peripheral Cathetersare a type of catheter is inserted into your arm near the inside of the elbow and threaded up inside your vein to a length of 6 inches.
It is no more painful than having a peripheral IV inserted because you don't feel the catheter moving up your vein.
These catheters typically last about six weeks -- a perfect catheter for a short course of antibiotics, but not really practical for long-term intravenous therapy.
The end of the catheter will reach a much larger vein with more blood flow and will cause less irritation
of the vein. Because the catheter is so soft and the end is well inside the vein, the chances of it dislodging are much less than with a peripheral IV. It will still need to be covered with a plastic dressing which needs to be kept clean and dry.
That means wrapping your arm in plastic wrap before a shower, or taking a bath instead, holding your arm out of the tub. Your nurse will clean the dressing and clean the site once a week or more. Because it is near the elbow, this type of catheter shows under a T-shirt, but it is hidden under a long-sleeved shirt. You can do most normal activities with this type of catheter, except swimming, as long as you are careful with the arm. This type of catheter also needs to be flushed with saline and heparin after each use or at least once daily if not in use. Blood may not be drawn for lab tests with this catheter. CENTRAL CATHETERS, PERIPHERALLY INSERTED These catheters are centrally placed, meaning the tip ends up in the Superior Vena Cava, which is the largest vein leading directly to the heart after collecting blood from the rest of the body. Even irritating medications can be given through a central catheter because there is enough blood flow past the catheter to dilute the drug. "Peripherally inserted" means it goes into your body at your elbow and the tip is threaded up into your vein. The Groshong type catheters have a valve at the tip, preventing blood from backing up into the catheter, so heparin is not necessary. Groshong catheters are usually thinner and more flexible than other types of catheters and don't require a clamp, which adds bulk to the others. These types of catheters are inserted by a nurse, and are usually no more painful than a peripheral IV insertion. After the catheter is inserted, a chest X-ray is required to make sure the tip is in the right location above the heart. There is a plastic dressing at the elbow which must be kept clean and dry at all times; it is changed and the site cleaned once a week or more by your nurse. These types of catheters usually last for six weeks to six months, but frequently last even longer than that. With this type of catheter, you can do most normal activities, except swimming or other extreme movements of the arm. You can also have your blood drawn from a central catheter instead of being "stuck" each time for lab tests, if your doctor allows. The Groshong needs just a saline flush after each use or once daily if not in use, while the Intrasil needs both saline and heparin flushes. CENTRAL CATHETERS, TUNNELLED Central Catheters, Tunnelled are catheter with tips that also end up in the Superior Vena Cava, but the other end is tunnelled about six inches away under the skin on the chest. On the catheter, inside this skin tunnel, is a Dacron cuff which your skin seals around, preventing bacteria from crawling along the outside of the catheter into the blood stream. Two popular brand names of this type of catheter are Hickman® and Groshong®. The Groshong catheters have a valve at the tip, tend to be lighter and more flexible and don't require a bulky clamp. They are usually more comfortable to "wear." These catheters are surgically placed as an outpatient procedure under local anesthesia. Afterwards, the shoulder area is somewhat sore for a few days but is tolerable. The catheter will usually exit the skin near the nipple area and since the end dangles out, it's always available for use. This makes it very easy to use for daily medications. You will usually be responsible for cleaning the catheter exit site and changing the the dressing daily. For the first two weeks after a tunnelled catheter insertion, the gauze dressing must remain dry and intact even in the shower which means covering it with a plastic dressing or plastic wrap or taking a tub bath while keeping your chest dry. After two weeks, the dressing can be changed immediately if it gets wet in the shower. The gauze dressing changes are easy to do, and once you get the hang of it, it's a quick process. Once your tunnelled catheter is healed completely (usually by six to eight weeks), the catheter site should just need a bit of soap in the shower and a plain bandage when you get out. Instead of daily gauze dressings, some patients prefer to have their nurse change the dressing once a week with a transparent plastic dressing -- but it has to be kept dry and intact. During the day, the catheter should be taped to the chest to prevent dangling or catching it on something. It won't be noticeable under T-shirts or even tank tops most of the time. You can usually have some say in the location of the exit site by discussing your preferences with the surgeon in advance. You might prefer it to exit on the left side if you always sleep on your right side, for instance. Remember, though, that the surgeon will need to choose the placement that will work the best with each patient's veins and chest. You can perform all normal daily activities when the shoulder is no longer sore, except for swimming. When the catheter is fully healed, some doctors will allow their patients to swim in a clean pool if the catheter site is covered with a plastic dressing meant to keep out water. Swimming in rivers, lakes or oceans is usually not allowed, and some doctors don't allow their patients to swim (or hot-tub) at all. Though these catheters are designed to be permanent, they are easily pulled out by your doctor with just a slight stinging sensation. The Groshong tunnelled catheter needs a saline flush after each medication or every one to seven d ays if not in use. The Hickman tunnelled catheter needs a saline and heparin flush after every medication or at least once daily if not in use. Blood can be drawn from a tunnelled catheter if your doctor consents. CENTRAL CATHETERS, IMPLANTED PORTS Implanted ports have all of the advantages of a central line except they are not always immediately available for use. A port is a small titanium reservoir with a rubber "stopper" that is attached to the catheter entering your vein below the collarbone. The whole thing is implanted under the skin in an outpatient procedure with local anesthesia and IV sedation. These catheters are usually not noticeable under your skin, but may sometimes show as a small lump. In order to use this catheter, the nurse must locate and clean the site, and place a special needle through the skin and into the rubber stopper. This can be done for each dose of medication or left in place with a plastic dressing and weekly changes. Ports that remain in place between usages are usually bulkier and more cumbersome to "wear" than a tunnelled catheter, and the dressing needs to be kept clean and dry. The ports are made to withstand 2000 needle entries, but this does not irritate the skin over the port. Most people develop a callus that quits hurting when the needle is placed through the skin. As a patient, you can be taught to clean the site and access the port with a needle, but it is difficult to learn and complicated to do. Because of the procedures involved in accessing the port for use, these catheters are usually not recommended for daily or more frequent medications. They are perfect for someone who gets a medication only once a week or for a week every six weeks or some other intermittent schedule. One type of implanted port is actually placed in the arm near the elbow and the catheter line threatened up the vein to the Superior Vena Cava, but they offer no particular advantage over a chest port, tend to have more complications, and are harder for the patient to self-access since two hands are almost required for the procedure. When the port is not accessed, it is hardly visible and requires no care other than a once monthly access for flushing with heparin. Patients with unaccessed ports can swim, though sometimes a doctor will recommend covering the site with a waterproof plastic dressing. Since the skin is an excellent barrier to bacteria, unaccessed ports rarely become infected. However, frequent accessing of a port, or leaving the access in place for extended periods can make the odds of infection greater than with a tunnelled-type catheter. Blood can be drawn from a port for lab tests, if you doctor consents. SOURCE: The STEP Program Seattle WA 1996 +++++++++++++++