Introduction

With very rare exceptions, all patients undergoing critical care will, at some stage during their admission, require an indwelling venous catheter or cannula for fluid and drug administration, invasive monitoring and therapeutic intervention. So ubiquitous is the role of venous access in current medical practice that it is rarely given much consideration in even the most comprehensive textbooks.

This chapter reviews the various sites of venous access, devices in common use, methods of insertion and removal and common complications.

Sites of venous access

Anatomical sites are usually divided into two categories: peripheral and central. Short-term (i.e., 1–3 days) access for infusions of crystalloids, colloids, blood products and nonirritant drugs can be achieved using small to medium sized (e.g. 22- to 14-G) cannulae in a peripheral (i.e., arm and leg) vein. Patients with ‘poor’ peripheral veins and those requiring long-term (>4 days) venous access, invasive monitoring, inotropic or irritant drugs (e.g. cytotoxic agents), intravenous feeding or therapeutic intervention typically require central venous access with larger (7- to 9-Fr) devices with one or more lumens. Placement of a ‘peripherally inserted central catheter’ (PICC) allows delivery to a central vein via a long (30- to 55-cm) indwelling catheter.