Jones - Scelta tra accesso venoso centrale vs. periferico

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Choice of line

Peripheral vs. Central

Dr Matt Jones

Consultant Anaesthetist -UK Clinical Lead for Vascular Access

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Goal of IV access

“Correct device, placed in the correct vein, at

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Goal of IV access

“Correct device, placed in the correct vein, at

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Peripheral vs. Central

• _{Definition (GAVeCeLT)}

Any catheter whose tip is positioned in the

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Peripheral vs. Central

• _Historically

– PIV, Midline, PICC (CICC/Port etc.)

• _{Focus on PIV vs. PICC vs. Midline}

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Line Choice

• _{Usually mostly based on algorithms of which}

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• DAV-EXP is an expert system developed by GAVeCeLT to present an algorithm for choosing the most suitable

venous access device (DAV) in a simple and clear way. • DAV-EXP è un sistema esperto messo a punto dal

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The DAV-EXP should not be considered as a ﬁxed reference guideline; line choice will remain a

clinical decision, made a]er assessing the needs of the individual pa^ent and the resources of

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Goal of IV access

“Correct device, placed in the correct vein, at

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Peripheral vs. Central

• _{What are the variables:}

– Patient issues – _{IV access device}

– _{For…(type and duration of iv therapy)} – _{Available equipment}

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Patient Issues

• _{Veins available, now and next}

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Available Equipment and Exper^se

• _{Very variable. Need to work with what you have}

• Specialist staff, Skilled staff

– _{PICC/midline EARLY, where indicated}

• _{ULTRASOUND and skills to use it – PROPERLY!}

• Do you have a wide range of IV access devices

available?

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Long, narrow gauge cannula (22), placed under ultrasound guidance in a good quality vein If needed for >24

hours then ensure placement in good

quality vein in good location

(TvB : WOCOVA)

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Specialist peripheral iv (PIV)

• _{“Simple” specialist peripheral cannulae}

• “Complex” specialist peripheral cannuale

– _{Inser^on skill} – _Gauge

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Our Experience

• _{Long, narrow PIVs, placed under ultrasound}

guidance, in a good vein, in a good loca^on, using best prac^ce, last A LONG TIME.

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Our Experience

• _{Use narrowest gauge you can}

– _{Be brave, 22G as standard}

• Long cannulae are revolu=onary

– _{Distance of ^p from vein wall puncture} – _{Especially in obese or those with lax skin}

• _{Less chance of catheter ^p coming out of vein}

– _{Especially in children}

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In Conclusion

Peripheral vs. Central

• _{Essential to consider all factors when deciding:}

– _{Skills, aftercare, device availability, next time etc.}

• Timely PICC

• _{Long, narrow PIVs, placed properly under}

ultrasound guidance, in a good vein, in a good location, following best practice, which are

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If all else fails, just put everything in…

CICC

PICC PIV

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Thank You for listening!

Dr Matt Jones

Consultant Anaesthetist -UK Clinical Lead for Vascular Access