Bleeding Disorders Treatment: Types of Venous Access
Venous access means creating a pathway to the bloodstream. If you are a person with hemophilia or von Willebrand disease (vWD) and your doctor recommends factor replacement treatment or other medications, there has to be a way to get it into the blood. This is usually done by inserting a needle into a vein.1,2
There are different types of venous access, each with advantages and disadvantages. In this section, you'll find basic information about living with hemophilia and vWD:
- The different types of venous access
- The advantages and disadvantages of each
It is important to remember that choosing a venous access option is not a one-time decision— you may move from one type to another as physical and lifestyle situations change.
Types of Venous Access
As you and your healthcare team make decisions about which type is right for you, it is important first to understand some basic information about the different options.
Peripheral Venous Access
Peripheral venous access involves infusing into the peripheral veins.1,2 Peripheral veins are veins away from the central part of the body, such as in the arms or hands. Peripheral venous access is strongly encouraged in the MASAC Recommendations, if veins are adequate and if the patient is old enough.3
A new needle must be reinserted each time treatment is needed. For people receiving frequent infusions or who have very small veins, the repeated sticks required for peripheral venous access can be a disadvantage.2,4
Central Venous Access
Central venous access refers to infusing factor and other medications into large veins in the chest. Central venous access devices (CVADs) are medical devices, inserted by a doctor, that allow factor and other medications to be delivered into one of these large veins.1,3
A bleeding disorder healthcare professional may recommend CVADs for a young child, because small veins and lack of cooperation can make repeated needlesticks difficult.3 CVADs may also be useful when urgent infusions are needed. Once a CVAD is implanted in the body, it may be used to administer factor over extended time periods3.
However, having an implanted device does have some disadvantages. With CVADs, there is an increased risk of infection and blood clots. CVAD care can be complex and require significant training. There is also risk of the device breaking or malfunctioning.3,4
For all of these reasons, it is recommended that CVADs be used only when peripheral access is not feasible and only for as long as medically necessary.3
- Cheung E, Baerlocher MO, Asch M, Myers A. Venous access: a practical review for 2009. Can Fam Physician. 2009;55(5):494-496.
- Jones P. Looking after the veins. World Federation of Hemophilia website. http://www1.wfh.org/publication/files/pdf-1174.pdf. Accessed May 10, 2018.
- MASAC Recommendations Regarding Central Venous Access Devices Including Ports and Passports. National Hemophilia Foundation. https://www.hemophilia.org/Researchers-Healthcare-Providers/Medical-and-Scientific-Advisory-Council-MASAC/MASAC-Recommendations/MASAC-Recommendations-Regarding-Central-Venous-Access-Devices-Including-Ports-and-Passports. Accessed January 26, 2017.
- Ewenstein BM, Valentino LA, Journeycake JM, et al. Consensus recommendations for use of central venous access devices in haemophilia. Haemophilia. 2004;10(5):629-648.