Central Venous Access Devices (CVADs)

Central Venous Access Devices (CVADs) 150 150 Tony Guo

Central Venous Access Devices (CVADs)

CVADs

  • Catheters placed in large blood vessels
    • Subclavian vein, jugular vein
  • Three main types
    • Centrally inserted catheters
    • Peripherally inserted central catheters
    • Implanted ports

 

  • Applications
  • Allows for frequent, continuous, rapid, or intermittent administration of fluids and drugs
  • Allow for giving drugs that are potentially vesicants
  • Used to administer blood/blood products and parenteral nutrition
  • Useful  for patients with limited peripheral vascular access or need for long-term vascular access
  • Hemodynamic monitoring
  • Venous blood samples
  • Injection of radiopaque contrast media
  • Advantages
  • Immediate access
  • Reduced venipunctures
  • Decreased risk of extravasation
  • Disadvantages
    • Increased risk of systemic infection
    • Invasive procedure

 

Centrally Inserted Catheter

  • Inserted into a vein in neck, chest, or groin with tip resting in distal end of superior vena cava
  • Non-tunneled or tunneled
  • Single, double, triple, or quad lumen
  • Examples of long-term (tunneled) catheters
    • Hickman
    • Groshong

 

  • CVC (Central venous catheters)
    • Two types of central venous catheters (inserted in the internal jugular vein or subclavian vein)
      • Tunneled
  • Placed under the skin and meant to be used for a longer duration of time
  • Non-tunneled
  • Designed to be temporary and may be put into a large vein near your neck, chest, or groin
  • PICC (inserted into a vein in arm)
    • Single or multilumen, non-tunneled
    • For patients who need vascular access for 1 week to 6 months
      • Used for patients who cannot use arm for BP or blood draw or medications
      • Advantages
        • Lower infection rate
        • Fewer insertion-related complications
        • Decreased cost
      • Complications
        • Catheter occlusion 
        • Phlebitis
      • Implanted Infusion Port
        • Central venous catheter connected to an implanted, single or double subcutaneous injection port
        • Port is titanium or plastic with self-sealing silicone septum
        • Drugs are injected through skin into port
        • Advantages
          • Good for long-term therapy 
          • Low risk of infection
          • Cosmetic discretion
        • Complications
          • Catheter occlusion
            • Clamped or kinked catheter
            • Tip against wall of vessel
            • Thrombosis
            • Precipitate buildup in lumen
          • Embolism
            • Catheter breaking
            • Dislodgement of thrombus
            • Entry of air into circulation
          • Infection
            • Contamination during insertion or use
            • Migration of organisms along catheter
            • Immunosuppressed patient
          • Pneumothorax
            • Perforation of visceral pleura
          • Catheter migration
            • Improper suturing
            • Trauma, forceful flushing
            • Spontaneous

      Nursing Management

      • Inspect catheter and insertion site
      • Assess pain
      • Change dressing and clean according to institution policies
        • Transparent semipermeable dressing or gauze dressing
        • Chlorhexidine preferred cleansing agent
      • Change injection caps
        • Have patient turn head to opposite side
        • Valsalva if no clamp
      • Flushing is important
        • Normal saline prefilled syringe
        • Use only 10 ml syringe or larger
        • Push-pause technique

      Removing CVADs

      • Should be done according to institution policy
      • Gently withdraw while patient performs the Valsalva maneuver
      • Apply pressure
      • Ensure that catheter tip is intact
      • Apply antiseptic ointment and dressing

      Things to consider to teach the patient with a PICC line

      • Proper technique for cleansing port prior to access
      • Proper flushing technique
      • How to administer antibiotic
      • S/S of occlusion and infection to monitor for
      • Who to call if symptoms of occlusion and infection
      • Importance of clamping catheter and keeping cap connection secure
      • What to do if catheter is inadvertently open to air

      How to remove a PICC line

      • Put on nonsterile gloves and remove dressing.
      • Don sterile gloves and mask; have patient turn head to other side.
      • Remove sutures if present.
      • Slowly and steadily withdraw catheter. If resistance is met, STOP.
      • If resistance is met—can apply warm compresses for 20 minutes and retry. If resistance continues, notify HCP.
      • Have patient perform the Valsalva maneuver as the last 5 to 10 cm of the catheter is withdrawn.  
      • Pressure should be immediately applied to the site with sterile gauze to prevent air from entering and to control bleeding. 
      • Inspect the catheter tip to determine that it is intact. 
      • After bleeding has stopped, apply an antiseptic ointment and sterile dressing to the site

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