What is a vascular (vas) catheter?

Vascular Catheter (Vas Cath) Definition and Types

A vascular catheter (vas cath) is a medical device providing access to the central veins or right atrium, permitting high-volume flow rates for the administration of fluids, medications, blood products, and for obtaining blood samples. 1

Types of Vascular Catheters

• Short-term catheters: Intended for use less than 1 week, typically not tunneled, and primarily used in hospitalized patients rather than for outpatient maintenance dialysis 1

• Long-term catheters: Also known as tunneled cuffed catheters (TCCs), these devices are intended for use longer than 1 week, are tunneled under the skin, and have a cuff to promote fibrous ingrowth to prevent catheter migration and accidental withdrawal 1

• Port catheter systems: Subcutaneous devices for hemodialysis access that are cannulated with needles; these contain a ball-valve system connected to one or more central venous catheters 1

• Peripheral venous catheters: Most commonly used short-term intravascular devices, usually inserted into veins of the forearm or hand; rarely associated with bloodstream infection 1

• Peripheral arterial catheters: Used for short-term monitoring of hemodynamic status and blood gas levels in critically ill patients; infection risk may approach that of central venous catheters 1

• Midline catheters: Peripheral catheters (7.6-20.3 cm) inserted via the antecubital fossa into proximal basilic or cephalic veins without entering central veins; associated with lower rates of phlebitis and infection than central venous catheters 1

Clinical Applications

• Hemodialysis access: Vascular catheters provide necessary access for patients requiring dialysis, with specific placement requirements to ensure adequate blood flow 1

• Medication administration: Allows for delivery of medications that may be irritating to peripheral veins or require rapid distribution 1

• Fluid resuscitation: Permits high-volume fluid administration in critically ill patients 1

• Hemodynamic monitoring: Certain catheters allow for pressure measurements and obtaining samples for laboratory analysis 1

• Parenteral nutrition: Central access may be required for solutions with high osmolarity (>850 mOsm/L) 2

Insertion Sites and Considerations

• Preferred insertion sites: The right internal jugular vein is often the preferred insertion site for central venous catheters 1

• Exit site: The location on the skin where the catheter exits the skin surface 1

• Insertion site: Location at which the catheter enters the vein 1

Complications and Risks

• Infectious complications: Include local site infection, catheter-related bloodstream infections (CRBSIs), septic thrombophlebitis, endocarditis, and other metastatic infections 1

• Thrombotic complications: Central venous catheters and peripherally inserted central catheters are associated with increased risk of venous thromboembolism 3

• Mechanical complications: Include pneumothorax, hemothorax, arterial puncture, and catheter malposition during insertion 2, 4

Prevention of Complications

• Antimicrobial catheters: Catheters impregnated with antimicrobial agents (such as chlorhexidine/silver sulfadiazine or minocycline/rifampin) can decrease the risk of catheter-related colonization and bloodstream infections 5

• Antibiotic/antimicrobial locks: Instillation of antibiotic or antimicrobial solutions into the lumen of dialysis catheters during the interdialytic period can help prevent infections 1

• Specialized vascular access teams: Dedicated teams for selecting, placing, and maintaining vascular access devices can improve outcomes and reduce complications 4

Clinical Importance

• Widespread use: Healthcare institutions purchase millions of intravascular catheters each year, with central venous catheters accounting for approximately 90% of all catheter-related bloodstream infections 1

• Economic impact: The attributable cost per catheter-related bloodstream infection is estimated at $34,508-$56,000, with annual costs ranging from $296 million to $2.3 billion in the United States 1

• Quality of life considerations: Fully implanted vascular access devices may improve patient quality of life by eliminating external tubes and reducing the need for routine external catheter care 6