Vascular Access Device Types: A Complete Comparison Guide
Complete comparison of all vascular access device types: PIV, midline, PICC, CVC, tunneled catheter, port, hemodialysis catheter, IO, and arterial line — with a clinical selection guide.
Vascular Access Device Types: A Complete Comparison Guide
Choosing the right vascular access device requires understanding the clinical characteristics, appropriate indications, and limitations of each device type. This guide provides a structured comparison of all major vascular access device types used in clinical practice.
Parent guide: Vascular Access: Complete Clinical Reference
The Complete VAD Spectrum
Peripheral IV Catheter (PIV)
Description: Short catheter (approximately 1.25–2.5 cm) inserted into a peripheral vein (dorsum of hand, forearm, antecubital fossa). The most common invasive procedure in healthcare.
| Feature | Detail |
|---|---|
| Tip location | Peripheral vein (hand, forearm, antecubital) |
| Dwell time | 72–96 hours; change per institutional protocol |
| Lumen count | Single |
| Osmolarity limit | <600 mOsm/L (strongly preferred) |
| Vesicants | Not appropriate |
| Blood draws | Limited; not standard practice in most settings |
| Placement | Any trained RN or qualified clinician |
| Infection risk | Low (no CLABSI risk; phlebitis and infiltration risk) |
Appropriate for: Most short-term IV medications, IV fluids, electrolyte replacement, single-dose medications, blood products (with appropriate gauge).
Not appropriate for: Therapy requiring osmolarity >600 mOsm/L, vesicants, TPN (standard), dwell >96 hours, or frequent blood draws.
Midline Catheter
Description: Longer catheter (approximately 8–25 cm) inserted via upper arm peripheral vein, with the tip terminating in the axillary or subclavian vein — below the thoracic cavity. Not a central venous access device.
| Feature | Detail |
|---|---|
| Tip location | Axillary or subclavian vein (peripheral) |
| Dwell time | 1–4 weeks |
| Lumen count | Single or double |
| Osmolarity limit | <600–800 mOsm/L |
| Vesicants | Not appropriate (peripheral tip) |
| Blood draws | Per institutional policy; some midlines acceptable |
| Placement | Credentialed RN or APRN with US guidance |
| Infection risk | Low-moderate; no CLABSI designation (peripheral device) |
Appropriate for: IV therapy 1–4 weeks not requiring central access (moderate-duration antibiotics, fluids, non-vesicant medications), patients with difficult peripheral access needing reliable access without PICC indication.
Not appropriate for: Central-access drugs (vesicants, TPN >900 mOsm/L), therapy >4 weeks, blood sampling in most settings.
PICC Line (Peripherally Inserted Central Catheter)
Description: Long catheter inserted via upper arm peripheral vein and advanced until the tip rests in the lower SVC at the cavoatrial junction (CAJ). Central access via peripheral insertion approach.
| Feature | Detail |
|---|---|
| Tip location | Lower SVC / cavoatrial junction |
| Dwell time | Weeks to months |
| Lumen count | Single, double, or triple |
| Osmolarity | Central tip — can accommodate >900 mOsm/L |
| Vesicants | Yes (central tip) |
| Blood draws | Yes (per protocol) |
| Placement | Credentialed RN (VAT), APRN, MD with US guidance |
| Infection risk | Low-moderate; CLABSI designation applies |
Appropriate for: IV therapy ≥5–7 days requiring central access, OPAT, TPN, chemotherapy, vesicants, multi-lumen needs. See PICC Line Indications.
Not appropriate for: ESRD patients (vessel preservation), short-term therapy (<5 days) with adequate peripheral access, patients with known DVT in target vein.
Non-Tunneled Central Venous Catheter (CVC)
Description: Catheter inserted directly into the IJ, subclavian, or femoral vein, with tip in the SVC or IVC. Short-term acute care device.
| Feature | Detail |
|---|---|
| Tip location | Lower SVC (IJ/subclavian) or IVC (femoral) |
| Dwell time | Days to approximately 2 weeks |
| Lumen count | Single to quad-lumen |
| Osmolarity | Central tip — all infusates |
| Insertion risk | Pneumothorax, hemothorax, arterial puncture |
| Placement | MD, PA, NP with privileges |
| Infection risk | Moderate; CLABSI risk varies by site (subclavian < IJ < femoral) |
Appropriate for: ICU hemodynamic monitoring, emergency central access, CVP monitoring, situations requiring immediate central access.
Not appropriate for: Stable patients requiring long-term therapy where PICC or tunneled catheter is safer and more comfortable.
Tunneled Central Venous Catheter (Hickman, Broviac, Groshong)
Description: Surgically placed catheter tunneled subcutaneously from entry vein to separate skin exit site. Dacron cuff promotes tissue ingrowth for anchorage and infection barrier.
| Feature | Detail |
|---|---|
| Tip location | Lower SVC |
| Dwell time | Months to years |
| Lumen count | Single to triple |
| Exit site | External; requires dressing |
| Placement | Interventional radiology or surgery |
| Infection risk | Lower than non-tunneled for comparable dwell |
Appropriate for: Long-term home IV therapy, stem cell transplantation, home TPN, chronic IV access needs where port is not feasible.
Implanted Vascular Access Port
Description: Subcutaneous reservoir connected to a central venous catheter. No external components between uses; accessed via non-coring Huber needle through skin.
| Feature | Detail |
|---|---|
| Tip location | Lower SVC |
| Dwell time | Years (device lifespan 10+ years) |
| External component | None between accesses |
| Access requirement | Huber needle + ANTT |
| Placement | IR or surgery |
| Infection risk | Lowest of all CVADs (per comparable dwell period) |
Appropriate for: Intermittent chemotherapy, long-term recurrent IV access, patients for whom body image/daily life impact is a priority.
Tunneled Hemodialysis Catheter
Description: Large-bore (12–14 Fr) dual-lumen tunneled catheter designed for high-flow dialysis access. Distinct from standard CVCs.
| Feature | Detail |
|---|---|
| Purpose | Hemodialysis (300–450 mL/min flow rates) |
| Tip location | Right atrium or IVC/RA junction |
| Flow rate | High-flow (dialysis-specific) |
| Infection risk | Highest of all CVAD types per catheter-day |
Appropriate for: Bridge hemodialysis access while waiting for AV fistula maturation; patients not suitable for surgical access.
Intraosseous (IO) Catheter
Description: Needle inserted into the bone marrow cavity (tibia, sternum, or humerus) for emergency vascular access.
| Feature | Detail |
|---|---|
| Dwell time | <24 hours |
| Purpose | Emergency resuscitation when IV unavailable |
| Flow rate | Adequate for emergency medications |
| Conversion | Must convert to IV access ASAP |
Arterial Line
Description: Catheter in the arterial system (radial artery preferred) for continuous hemodynamic monitoring and serial blood gas sampling.
| Feature | Detail |
|---|---|
| Purpose | Blood pressure monitoring; ABG sampling |
| Medications | Limited; arterial drug delivery is hazardous |
| Placement | MD, PA, NP in most settings |
| Infection risk | Lower than CVCs; arterial infection is serious |
Comparison Summary Table
| Device | Tip | Dwell | Vesicants | TPN | CLABSI Risk |
|---|---|---|---|---|---|
| PIV | Peripheral | 72–96h | No | No | None |
| Midline | Peripheral | 1–4 wk | No | No | None |
| PICC | Central (SVC) | Wk–months | Yes | Yes | Low–moderate |
| Non-tunneled CVC | Central | Days | Yes | Yes | Moderate |
| Tunneled CVC | Central | Mo–years | Yes | Yes | Low |
| Implanted Port | Central | Years | Yes | Yes | Lowest |
| HD Catheter | Central/RA | Mo | No | No | Highest |
| IO | Intraosseous | <24h | Emergency | No | Minimal |
| Arterial line | Arterial | Days | No | No | Low |
Related Resources
References
- Gorski LA, et al. (2021). INS Infusion Therapy Standards of Practice. J Infus Nurs, 44(Suppl 1).
- Chopra V, et al. (2015). MAGIC criteria. Ann Intern Med, 163(6 Suppl).