Understanding the Different Types of Vascular Access

November 1, 2025 •

3 min read

According to the National Kidney Foundation, the arteriovenous (AV) fistula is considered the 'gold standard' for long-term vascular access due to its high patency rates and low risk of complications. Vascular access is a critical procedure that provides a reliable port for delivering medications, fluids, or dialysis treatments directly into a patient's bloodstream.

Quick Summary

A vascular access provides a dependable entry point into the bloodstream for medical treatments. Primary types include peripheral intravenous catheters for short-term use and central venous catheters, AV fistulas, and grafts for longer-term needs like dialysis or chemotherapy. Selection depends on the patient's condition and treatment duration.

Key Points

Peripheral vs. Central Access: The main types of vascular access are broadly categorized as peripheral (inserted into smaller, outer veins) for short-term use and central (inserted into large, central veins) for longer-term, more complex treatments.
Long-term Options: For long-term needs like dialysis or chemotherapy, options include surgically created AV fistulas and grafts, tunneled CVCs, and implanted ports, each with distinct benefits and risks.
AV Fistula is Gold Standard: The AV fistula, created by connecting a patient's artery and vein, is the preferred long-term access for hemodialysis due to its durability and lower complication rates.
Minimizing Complications: Risk of complications like infection and clotting can be managed by selecting the most appropriate device for the treatment duration and providing proper care.
Factors for Selection: Device selection is a patient-centered decision, considering treatment duration, vein health, infection risk, and the specific type of medication or therapy required.
Implanted Port Benefits: For intermittent, long-term treatments like chemotherapy, an implanted port offers convenience and a lower infection risk when not in use.

What is Vascular Access?

Vascular access is the medical process of creating a connection to a patient's bloodstream for the purpose of administering treatments, drawing blood, or monitoring physiological data. While a standard peripheral intravenous (IV) line is the most common form of short-term access, many conditions require a more robust, long-lasting, or secure route. The type of vascular access chosen depends on several factors, including the planned duration of therapy, the type of substance being delivered, and the patient's vein condition. Understanding the options is crucial for both healthcare providers and patients to ensure the safest and most effective care.

Temporary Vascular Access

Temporary access is typically used for short durations or in emergencies. The most common types include peripheral intravenous catheters and non-tunneled central venous catheters.

Peripheral Intravenous Catheter (PIVC): Inserted into a small vein in the hand or arm for administering fluids or medications for a few days.
Non-Tunneled Central Venous Catheter (CVC): Placed in a large central vein for rapid access or irritating solutions, typically for less than two to three weeks due to infection risk.

Long-Term Vascular Access

For treatments lasting weeks, months, or years, long-term devices are necessary to minimize complications from frequent vein punctures. These include PICC lines, tunneled CVCs, implanted ports, AV fistulas, and AV grafts.

Peripherally Inserted Central Catheter (PICC) Line: Inserted in the arm and advanced to a central vein, used for extended IV therapy and chemotherapy for weeks to months.
Tunneled Central Venous Catheter (CVC): Surgically placed in a large vein, tunneled under the skin with a cuff for stability and infection barrier, used for long-term dialysis or chemotherapy.
Implanted Port (Port-a-Cath): A reservoir under the skin connected to a central vein, accessed with a special needle. Used for intermittent, long-term treatments like chemotherapy, offering lower infection risk when not accessed.
Arteriovenous (AV) Fistula: A surgical connection between an artery and vein. It is the preferred long-term access for hemodialysis, requiring weeks to months to mature.
Arteriovenous (AV) Graft: A synthetic tube connecting an artery and vein, used when veins are unsuitable for a fistula. Offers quicker use for hemodialysis than a fistula but with higher risk of clotting and infection.

Comparison Table of Vascular Access Types


Feature	Peripheral IV	PICC Line	Implanted Port	AV Fistula	AV Graft
Duration	Short-term (days)	Medium-term (weeks-months)	Long-term (months-years)	Long-term (years)	Long-term (years)
Placement Site	Hand, arm	Arm	Chest, upper arm	Arm	Arm, leg
Surgical Procedure	No (bedside)	No (bedside)	Yes	Yes	Yes
Access Method	Needle	Needle	Huber needle through skin	Two needles during dialysis	Two needles during dialysis
Key Benefit	Quickest, simplest access	Less invasive than CVC	Lowest infection rate when unaccessed	Lowest complication rate	Quicker use than AV fistula
Key Drawback	Short lifespan, vein damage	Restricted arm activity	Needle access required	Maturation time needed	Higher clotting/infection risk than fistula

Potential Complications of Vascular Access

Complications can include infection, blood clots (thrombosis), vessel narrowing (stenosis), device migration, and bleeding. Proper care and timely intervention are key to managing these risks.

Factors Influencing Vascular Access Selection

Selecting the right access method involves considering treatment duration, patient health and vein condition, lifestyle factors, and the specific type of treatment required. Long-term therapies often require central lines or surgically created accesses, while irritating medications necessitate larger central veins.

Conclusion

Choosing the optimal vascular access is a crucial, personalized decision based on a patient's clinical needs, lifestyle, and treatment duration. Options range from temporary peripheral IVs to long-term solutions like AV fistulas for hemodialysis. Healthcare professionals must carefully weigh the risks and benefits of each type to ensure safe and effective patient care and improve treatment outcomes. Learn more about optimal vascular access selection at The National Kidney Foundation.

Frequently Asked Questions

A PICC line is a type of central line, but it is inserted into a peripheral vein in the arm, whereas a standard central line is inserted directly into a large central vein in the neck, chest, or groin. PICC lines are less invasive to place than tunneled central lines.

For long-term hemodialysis, the arteriovenous (AV) fistula is considered the best option. It is created by connecting an artery and vein, and once matured, offers excellent blood flow and the lowest risk of infection and clotting compared to grafts and catheters.

Proper care includes maintaining good hand hygiene, keeping the access site clean and dry, securing dressings, and following specific instructions from your healthcare provider. Patients should report any signs of infection, such as redness, swelling, or pain.

It depends on the device. For external catheters like PICC lines or tunneled CVCs, the site must be covered to prevent it from getting wet. With an implanted port, showering and swimming are possible once the incision is healed and the port is not accessed.

Risks include infection, blood clots (thrombosis), vessel narrowing (stenosis), and device malfunction or migration. Healthcare providers take precautions to minimize these risks.

In an emergency, a non-tunneled central venous catheter (CVC) can be placed quickly at the bedside into a large vein, such as the jugular or femoral vein. Another rapid option for critically ill children is intraosseous (IO) infusion into the bone marrow.

A PICC line can typically remain in place for weeks to several months, depending on the patient's treatment needs. It is often used for extended courses of IV antibiotics or chemotherapy.

An implanted port is a device with a small reservoir placed completely under the skin and connected to a central vein. To use it, a specialized needle is inserted through the skin into the reservoir to deliver medicine or draw blood.