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Apex Nursing

Reference — IV Therapy

Vascular Access Devices Reference

Peripheral IV, midline catheter, PICC, central venous catheter (CVC), and implanted port — compared by indication, dwell time, tip location, flushing, dressing, and key nursing considerations.

Educational use only. Vascular access device selection requires interprofessional collaboration and clinical assessment. All central lines require provider order and placement confirmation before use. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

Quick Comparison

DeviceTip LocationDwell TimeCentral?TPN / Vesicants?
Peripheral IVPeripheral vein72–96 hoursNoNo
MidlineAxillary vein (below SVC)1–4 weeksNoNo
PICCSuperior vena cavaWeeks–monthsYesYes (CXR required)
CVC (non-tunneled)Superior vena cava / IVCDays–weeksYesNo
Implanted PortSuperior vena cavaYears (intermittent)YesYes

Device Details

Peripheral IV Catheter (PIV)

PIV

Insertion Site: Forearm (cephalic, basilic, median antebrachial), dorsal hand, antecubital (last resort)

Tip Location: Remains in peripheral vein — does not reach a central vein

Dwell Time: 72–96 hours per CDC/facility policy; remove as soon as no longer needed

Gauge/Size: 14–24 G (18–20 G most common in adults)

Flushing: Flush with 5–10 mL NS before and after each use; every 8–12 hours if not in use

Dressing: Transparent semipermeable dressing; change when soiled or loose; label with date/time/gauge

Indications

  • Short-term fluid and medication administration
  • Blood draws when no other access is available
  • Blood transfusions (≥18 G required)
  • Emergency vascular access

Contraindications

  • Vesicant medications (chemotherapy, concentrated vasopressors)
  • TPN (requires central access)
  • pH <5 or >9 solutions
  • Osmolarity >600 mOsm/L
  • Long-term IV therapy (>6 days)

Advantages

  • Easiest to insert — bedside placement by any trained nurse
  • Lowest cost
  • Easily changed if complications develop
  • No imaging required

Limitations

  • Short dwell time — requires replacement every 72–96 hours
  • Cannot be used for vesicants or TPN
  • High infiltration/phlebitis rate with irritating medications
  • Limited to isotonic or near-isotonic solutions

Complication rate: Low per insertion; high cumulative rate given frequency of changes

Midline Catheter

Midline

Insertion Site: Basilic, cephalic, or brachial vein in upper arm; inserted at or above the antecubital fossa

Tip Location: Tip terminates at or below the axillary vein — does NOT reach the superior vena cava (NOT a central line)

Dwell Time: 1–4 weeks (up to 29 days)

Gauge/Size: 3–5 French (dual-lumen available)

Flushing: Flush with 10 mL NS before and after use; flush with 5 mL NS + 2.5 mL heparin (per policy) when not in use

Dressing: Transparent dressing, changed every 7 days or when compromised; use chlorhexidine disc if available

Indications

  • IV antibiotics requiring 1–4 weeks
  • Hydration and maintenance fluids
  • Blood draws
  • Patients with poor peripheral venous access who do not require central access

Contraindications

  • TPN
  • pH <5 or >9 solutions
  • Osmolarity >600 mOsm/L
  • Vesicant medications
  • Continuous vesicant infusions

Advantages

  • Longer dwell time than PIV
  • No daily site changes
  • More comfortable for longer-term use
  • Does not require X-ray confirmation for standard placement

Limitations

  • Not a central line — cannot be used for TPN or hyperosmolar solutions
  • Requires trained inserter or ultrasound guidance
  • Risk of thrombosis (basilic vein is lower risk than cephalic)

Complication rate: Lower than PIV for per-day complication risk; similar CLABSI risk to peripheral IV

Peripherally Inserted Central Catheter (PICC)

PICC

Insertion Site: Basilic (preferred), cephalic, or brachial vein in the upper arm; threaded into the superior vena cava

Tip Location: Superior vena cava (SVC) — confirmed by chest X-ray before first use

Dwell Time: Weeks to months (6–12 months or longer)

Gauge/Size: 3–6 French; single, double, or triple lumen

Flushing: Flush each lumen with 10 mL NS before and after each use; flush with 5 mL heparin solution when not in use (per policy); power-injectable PICCs flush with 20 mL NS after contrast injections

Dressing: Change every 7 days or when soiled/loose; use CHG-impregnated dressing; secure and document external catheter length at each assessment

Indications

  • Long-term antibiotics (>6 days)
  • TPN (requires SVC tip position)
  • Chemotherapy (vesicants)
  • Repeated blood draws
  • Long-term IV access when no other option is appropriate

Contraindications

  • Patients with limited arm movement (AV fistula, lymphedema, mastectomy side)
  • Inability to confirm SVC tip position
  • Bacteremia at time of insertion

Advantages

  • Central line capabilities without thoracic insertion
  • Bedside insertion by trained RN or PICC team
  • Lower infection risk than CVC if maintained correctly
  • Power-injectable models allow CT contrast administration

Limitations

  • Tip must be confirmed before use — X-ray required
  • Cannot use arm with PICC for blood pressure measurement
  • Arm movement restrictions
  • Thrombosis risk (basilic preferred over cephalic)
  • Requires trained inserter (PICC certified RN or IR)

Complication rate: CLABSI risk similar to other central lines; DVT risk in upper extremity

Central Venous Catheter (CVC)

CVC / CVL

Insertion Site: Internal jugular (IJ), subclavian (SC), or femoral vein; tip in the SVC (IJ/SC) or IVC (femoral)

Tip Location: Superior vena cava (for IJ/SC) — confirmed by chest X-ray before first use

Dwell Time: Days to weeks (non-tunneled: typically 5–7 days; tunneled CVC: months to years)

Gauge/Size: Single to quad-lumen; large bore (may run rapid infusions)

Flushing: Flush each lumen with 10 mL NS; heparin per facility protocol for unused lumens

Dressing: Transparent dressing every 7 days; gauze dressing every 2 days; change immediately if soiled or loose; CHG-impregnated dressing preferred

Indications

  • ICU/critical care patients
  • Vasopressors and vasoactive infusions
  • TPN
  • Chemotherapy
  • Hemodialysis (if tunneled: Hickman, Broviac; if non-tunneled: Shiley)
  • CVP monitoring
  • Pulmonary artery catheter (PA line) insertion port
  • Rapid volume resuscitation (large bore)

Contraindications

  • Active infection over insertion site
  • Coagulopathy (relative — site-dependent)
  • Bilateral pneumothorax (avoid subclavian if contralateral pneumothorax)

Advantages

  • Multiple lumens — allows simultaneous incompatible infusions
  • Large bore — allows rapid fluid administration
  • Central monitoring — CVP, SaO₂
  • Can administer all medication types including vesicants and TPN

Limitations

  • Highest risk device for CLABSI
  • Requires physician or APRN for insertion
  • Femoral site: highest infection and thrombosis risk — avoid when possible
  • Pneumothorax risk with subclavian insertion
  • Must confirm placement with CXR before use

Complication rate: Highest CLABSI risk of all access types; highest insertion complication risk

Implanted Port (Port-a-Cath)

Port

Insertion Site: Tunneled under skin in the chest wall; catheter tip in the SVC

Tip Location: Superior vena cava — verified initially by imaging; periodic assessment of port position

Dwell Time: Years; accessed intermittently

Gauge/Size: Accessed with non-coring (Huber) needle — must use correct needle type to preserve septum integrity

Flushing: Flush with 10 mL NS after each use; flush with heparin (typically 100–500 units in 5 mL NS) between accesses per facility protocol

Dressing: No dressing when not accessed; transparent dressing over Huber needle when accessed; remove needle after each use unless continuous infusion ordered

Indications

  • Long-term or intermittent IV therapy (chemotherapy, monthly IVIG)
  • Patients who need IV access over months to years but only intermittently
  • Prevents repeated peripheral venipunctures

Contraindications

  • Active infection
  • Allergy to port materials
  • Unable to access (damaged, occluded, or displaced port)

Advantages

  • Lowest infection risk when accessed correctly — port is fully implanted under skin
  • No external components when not accessed — patient can swim, shower freely
  • Very long dwell time — years to decades
  • High patient acceptance for long-term therapy

Limitations

  • Requires surgical implantation (interventional radiology or OR)
  • Must use only non-coring Huber needle — regular needles permanently damage the septum
  • Not appropriate for rapid fluid resuscitation
  • Requires patient and nurse education for correct access technique
  • Difficult to replace if infected — requires surgical procedure

Complication rate: Lowest per-day CLABSI rate of all central devices; highest consequence if infection develops (full port removal often required)

Key Nursing Rules

  • ✦Never use a regular (coring) needle to access an implanted port — always use a non-coring Huber needle to preserve the septum.
  • ✦Confirm tip placement with chest X-ray before first use of any PICC or central line — document the external catheter length at every assessment.
  • ✦PICC lines should not have blood pressure cuffs applied to the arm of insertion — can damage the catheter.
  • ✦Midline catheters are NOT central lines — do not use for TPN, vesicants, or hyperosmolar solutions.
  • ✦Femoral CVCs have the highest infection and thrombosis risk — use only when upper sites are unavailable.
  • ✦Scrub the hub: clean needleless connectors for ≥15 seconds with CHG or 70% alcohol before every access.
  • ✦For blood transfusions: only 0.9% NS is compatible — never use LR (calcium causes clotting) or D5W.
  • ✦CLABSI prevention bundle: hand hygiene, maximum sterile barrier, CHG skin prep, optimal site selection, daily review of necessity.

Related Resources

Vascular Access Comparison ChartSide-by-side chart: device, duration, advantages, limitations, typical use
Open →
Peripheral IV Insertion BasicsSite selection, gauge, insertion steps, securement
Open →
IV Therapy ComplicationsCLABSI, infiltration, phlebitis, air embolism, occlusion
Open →
IV Infiltration vs ExtravasationRecognition, interventions, and when vesicants require central access
Open →
IV Drip Rates ReferenceFlow-rate formulas and standard infusion ranges
Open →

Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with Infusion Nurses Society (INS) Standards of Practice · CDC (CLABSI prevention) · Institute for Safe Medication Practices (ISMP). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →