1. Different Types of IV and Dialysis Accesses
By Emily Weatherford MSN RN

2. Types of IV accesses Peripheral Central Simple Inexpensive
Used for short-term therapy
Site has to be rotated every hours
Used for long-term medication, IV fluid, blood product therapy
Used when patient requires large quantities of IV fluids, blood or medication
Administration of harmful medications like chemotherapy
Poor or inaccessible peripheral venous access

3. Peripherally Inserted IV catheters

4. Midlines
Midline catheters are inserted into the antecubital (or other upper arm) vein. They are typically 20 cm long and their tips do not reach the central veins of the thorax so they are considered peripheral accesses not central lines.
Used for IV therapy 1-4weeks
Not recommended for vesicants or highly irritating medications such as chemotherapy

5. Midline

6. Central Lines

7. Types of Centrally Inserted Catheters
Skin-tunneled catheters
Non-tunneled catheters
Implanted ports

8. Skin-tunneled Catheters
(Hickman or Groshong catheters) more long-term; reduces the incidence of infection by increasing the distance between the skin entry site and the venotomy; complications include thrombosis, occlusion, and infection

9. Non-tunneled Catheters
(Quinton catheters) short-term access in the emergency room, operating room and intensive care unit; used for rapid rescusitation and pressure monitoring; can be used for short-term dialysis

10. Implanted Ports
(Lifeports, Powerports) consists of a catheter attached to a reservoir that is implanted into a surgically created pocket on the chest wall or upper arm

11. PICC Lines

12. Peripherally Inserted Central Catheter (PICC)
Inserted in the basilic, cephalic, or brachial veins
Easier and safer insertion than centrally inserted catheter
Used for long-term therapy from several weeks to 6 months
Can be used for long-term chemotherapy, parental nutrition, blood products, antibiotics and other medication therapy
Complications include dislodgment, occlusion, mechanical phlebitis, and deep vein thrombosis (DVT)

13. Dialysis Accesses

14. Types of Hemodialysis Accesses
Long-term access (Assess for thrill and bruit)
AV graft
AV Fistula
Temporary access (No thrill or bruit)
Dialysis catheter

15. Arteriovenous Fistula (AV fistula)
Lasts the longest, years
Requires surgery to connect artery to vein and takes the longest to develop, may take as long as 24 months before it can be used for dialysis
Less likely to form clots or get infected
Nurse should assess for thrill and bruit

16. Arteriovenous Graft
Can last several years if well cared for but more likely than fistulas to get clotted or infected
Requires surgery to connect an artery to a vein using a synthetic tube, or graft
Can be used for patients with small veins that will not be able to develop a fistula
Takes less time to heal 2-3 weeks; Nurse should assess for thrill and bruit
For long-term dialysis

17. Dialysis Catheters Used when there is an immediate need for dialysis
Not for permanent use
Tunneled catheters can be used for longer-term dialysis, longer than 3 weeks but still prone to infection
Can be inserted in the neck, chest or groin

18. Reference
Cheung, E., Baerlocher, M. O., Asch, M. (2009). Venous Access. Canadian Family Physician. 55(5), Retrieved from