When selecting a vascular access device (VAD), it is important to:

• Minimize the size of the catheter; select smallest catheter possible to achieve goal
• Reduce the number of lumens; fewer lumens equals less risk for infection
• Select the largest vessel possible in order to maximize dilution
• Select location and/or extremity that is the healthiest and least damaged
• Plan by selecting a device that is the least invasive but most appropriate given the patient's vascular access needs
• Seek to accomplish appropriate device selection within 24 hours of admission and placement within 48 hours of admission
• Consult your IV or Vascular Access Team to assist with patient evaluation
• Reassess patient's condition and need for the same or different type of vascular access device if an IV complication occurs
• Perform risk assessment and planning to achieve better outcomes

The Vessel Health and Preservation Protocol provides the steps to ensure timely, reliable access from any portal of hospital entry using the device most specific to the patient's medical condition that helps preserve vessel health.

There are three main types of CVC devices: Nontunneled, tunneled and implanted ports. Each of these devices has an intended purpose and should be used according to the manufacturer's instructions for use and in accordance with national standards of practice or guidelines (INS or CDC).

Selection of the most appropriate device for a specific patient is aided using the Vessel Health and Preservation Right Line Tool. The Right Line Tool reviews the diagnoses/conditions that apply to the patient and guides you through a series of decisions that lead to the most appropriate device. If more than one device is suggested, you should choose the device that allows for the safest delivery of all prescribed medications. The protocol then guides you through the Right Patient Tool to determine if the patient has risk factors, complications or a medical history that contraindicates use of the indicated line (10).

For example, patients in critical condition need a device with multiple access ports to allow high flow gravity infusions such as a triple lumen (and perhaps antimicrobial) CVC. Patients undergoing dialysis need to preserve vasculature for long term access and should not receive a peripherally inserted central catheter (PICC). While a PICC may be indicated based on the Right Line Tool, the Right Patient Tool provides a more in-depth patient analysis and indicates the best initial device to be a dual dialysis catheter with an additional CVC infusion port, or a traditional dialysis catheter (10).

In situations where a patient requires parenteral nutrition, a device enabling maximum dilution of the intravenous nutrition is necessary. If nutrition is required for only a few days and a PICC is contraindicated, a centrally inserted CVC is acceptable. Patients with chronic nutritional needs require an implanted port. Some acute patients who require irritating medications or prolonged infusion therapy may also benefit from use of a central venous access device (10).