Anatomy and physiology of venous system vascular access: implications.

Ideal characteristics for long-term vascular access that can be managed in the home environment include a large vascular lumen in a high-flow blood system to minimize risks of obstruction and phlebitis, ease of sterile dressing maintenance, patient comfort, and longevity of the access site. Additionally, adaptation to placement at the bedside or in the home, technical ease and safety of placement, and minimal expense would be beneficial. With these considerations, possible anatomical sites would include the external and internal jugular veins, subclavian vein, cephalic vein, basilic vein, femoral vein, right atrial appendage, and translumbar and transhepatic access to the inferior vena cava. Of these, the internal jugular vein, subclavian vein, cephalic vein, basilic vein, and femoral vein would seem best suited for long-term venous access.