Effective long-term venous access is a cornerstone of safe and sustainable home parenteral nutrition (HPN) in patients with chronic intestinal failure. This chapter provides a comprehensive overview of central venous access devices (CVADs), including their types, insertion techniques, maintenance protocols, and associated complications. It outlines criteria for selecting appropriate vascular access devices, emphasizing the importance of multidisciplinary planning, patient-specific factors, and infection prevention strategies. Key complications such as catheter-related bloodstream infections, thrombosis, occlusion, and mechanical failures are discussed in detail, along with evidence-based approaches to prevention and management. Advances in antimicrobial-coated catheters and other innovations are also reviewed, underscoring the evolving landscape of vascular access in HPN.