Vascular Access and Catheter Management
Device selection
Choice of device follows duration, infusate characteristics, vessel suitability, and patient preference. Peripheral short catheters suit short courses of non-vesicant therapy; midline and peripherally inserted central catheters extend dwell; central venous catheters are required for vesicants, hyperosmolar solutions, and central pressure monitoring. Understand the difference between tip location requirements for central devices (cavoatrial junction region) versus peripheral devices.
Insertion and maintenance
Aseptic technique, maximal sterile barriers for central insertion, skin antisepsis with adequate dry time, and securement are core. Maintenance bundles include scrub-the-hub, assessment of dressing integrity, and daily review of continued need. Flush and lock volumes follow device type; use the appropriate syringe size to avoid excessive pressure on small lumens.
Traps
Questions conflate occlusion with infection or infiltration with extravasation. Infiltration is non-vesicant leakage into tissue; extravasation is vesicant leakage and requires specific antidote protocols. Another trap: removing a device for fever without considering whether the device is the source, or leaving a non-functioning device in place because it is not obviously infected. Never force a flush against resistance.
Rule of thumb
When resistance is met, stop; do not flush. Investigate (position, clamp, kink, thrombus) before any pressure is applied.
Worked example
A central catheter will not aspirate blood but infuses without resistance. This suggests tip malposition or fibrin sheath rather than complete occlusion. The answer is to stop use and evaluate - not to forcefully aspirate or to increase flush pressure.