Intravenous Access Basics and History
Peripheral intravenous lines are placed in any of the veins not included in the chest or abdomen and are normally placed in the arms, legs and sometimes the head. The first experiments with peripheral IV injections were in the 1600s using quills from bird's feathers and bladders of animals as instruments. IV access advanced during the cholera epidemic of 1831-1832. Dr. Thomas Latta of Scotland pioneered the use of IV saline infusion in dying cholera patients and publicly reported his results in the June 1832 issue of the Lancet. Due to the waning of the cholera epidemic, general medical skepticism and Dr. Latta's death in 1833, the technique essentially disappeared for the next 70 years. IV therapy did not become a routine practice until its use in World Wars I and II.
Today, over 1 billion peripheral IVs are placed globally each year.
Central lines are intravenous lines designed to be placed in large veins, most commonly the large veins in the neck, chest and groin. The catheter tip is placed right above the heart, in the lower part of the superior vena cava or cavoatrial junction. Central venous catheterisation was first performed in 1929 when Werner Frossman, a German doctor, inserted a ureteric catheter into his antecubital vein. He then walked to the radiography department so that the catheter could be guided into his right ventricle using x-ray. Since then, central venous access has become a mainstay of modern clinical practice. (1)
Central lines are used to administer medications that would harm smaller peripheral veins. Within North America and Europe, ultrasound is almost always used to place a hollow needle into the desired vein. A guidewire is then passed through the needle and directed to its desired location and finally a catheter is passed over the guidewire. The guidewire is then removed and thrown away. Central lines can have multiple lumens (ports) for injecting different fluids, and can sometimes have up to five lumens. For an animated video on central line insertion click here.
Peripherally inserted central catheters
Peripherally inserted central catheters (PICCs) are inserted through a peripheral vein and have a catheter that varies in length from 25 to 60 cm in length and extends to the superior vena cava by the heart. PICCs are inserted most commonly by doctors, respiratory therapists, or specially trained registered nurses using ultrasound, chest x-rays and fluoroscopy to aid in insertion and confirm placement. The PICC has a guide wire inside that is used to thread the catheter tip to its desired location, and then the wire is removed and thrown away. The optimal amount of time a PICC can stay in the body is not certain and is the point of many studies, but PICCs are often kept in place for weeks and sometimes for longer than a year.(2) Most PICCs are designed to accommodate power injection. Power injection is the insertion of a contrast media into the blood stream that illuminates in an x-ray or CT-scan.
Studies estimate that between 5 and 7 million central lines/PICCs are used annually in the United States.
1. Smith Reston N, Nolan Jerry P. Central venous catheters BMJ 2013; 347 :f6570
2. Cotogni, P., et al., Peripherally inserted central catheters in non-hospitalized caner patients; 5-year results of a prospective study. Supportive Care in Cancer 2015, 23, 403-409 http://doi.org/10.1007/s00520-14-2387-9