Access Devices Flashcards
Pinch off syndrome
Catheter compressed between first rib and clavicle, causing intermittent compression and pinching leading to intermittent occlusion of the infusion and aspiration
- Increased risk of catheter fracture
- Raise or lower the arm can usually relieve the occlusion and is hallmark sign of syndrome
- Catheter must be removed and reinsert in a more lateral position to subclavian vein
Superior vena cava syndrome
SVCS is caused when the flow of blood in the SVC vein slows.
- This vein carries blood from the head, neck, chest, and arms to the heart.
- Blood flow may be slowed by a blood clot, a tumor, or because the vein is being compressed by nearby tissue
- SVCS is most often seen in people with cancer. It’s most common with lung cancer or non-Hodgkin lymphoma
Superior vena cava syndrome symptoms
- swelling of the face, neck, upper body, and arms
- upper extremity swelling
- distended neck veins
- cough
- dyspnea (difficult/labored breathing)
- orthopnea (discomfort when breathing while lying down flat)
- dysphagia
- headache
- dizzy/lightheaded
- rapid breathing
- coughing up blood
Swelling also seen in catheter migration - but is less extensive and just includes neck and/or chest
Catheter migration & symptoms
This occurs when the catheter has moved from where it was first placed
Signs of a migrated catheter include:
- Increased length of the external catheter
- Swelling in the neck or chest during an infusion
- Pain or discomfort during the infusion
- No blood return
- Leaking at the catheter site.
Swelling also seen in superior vena cava syndrome - but is more extensive
Thrombotic catheter occlusions include:
Formation of thrombus within, surrounding, or at tip of catheter
- intraluminal thrombus
- fibrin sheath
- fibrin tail
- mural thrombus
Fibrin tail or flap
- Extends from the catheter tip but is drawn inward, blocking the opening of the catheter lumen on aspiration attempts
- Results in an ability to infuse fluids but an inability to withdraw blood
Intraluminal thrombus
- Occurs when blood refluxes inside the catheter lumen
- Common causes of reflux include coughing, inadequate flushing after blood draws or after checking for blood return, or improper use of flush syringes
Mural thrombus
- Forms where the catheter touches or “rubs” the vein wall
- Common sites are the entry site, anywhere along the catheter path, and the catheter tip
Fibrin sheath
- Forms when fibrin adheres to the external catheter surface, which may include the entry site, and may encase all or part of the catheter like a sock
- May completely cover the opening of the catheter tip
Management of thrombotic occlusions
Proper flushing AKA Pulsatile flushing technique
- 10 ml NaCl
- push pause flushing method
Declotting solutions
- tissue plasminogen activator
Inability to aspirate blood but still having ability to infuse through CVC suggests what type of occlusion?
A. Pinch off syndrome
B. Intraluminal thrombus
C. Calcium phosphate precipitate occlusion
D. Fibrin sheath/tail
Fibrin sheath/tail
How do intraluminal thrombus and calcium precipitate typically present?
Inability to infuse
Inability to aspirate
Nonthrombotic catheter occlusions include:
Precipitates
- Drug crystallization
- Drug-drug incompatibilities
- Drug-solution incompatibilities
Mechanical and malposition obstructions:
- Clamp on catheter
- Kinked catheter
- Tight retaining suture
- Pinch off syndrome
- Migration
Lipid residue
- Can accumulate in central venous catheters
- Often follows the administration of lipid-containing, TNA or drugs with oleaginous vehicles
Drug precipitates in the catheter may occur in conjunction with thrombus formation and should always be considered during assessment of an occlusion, since this may have implications for how the occlusion should be managed
How to manage precipitate occlusions
0.1 N hydrochloric acid
* Acidic precipitates (pH <6) like vancomycin, calcium-phosphate precipitates
70% ethyl alcohol or sodium hydroxide (0.1 mmol/mL)
* Lipid residue/precipitates
Sodium bicarbonate (1 mEq/mL)
* Alkaline drug precipitate (pH >7) like phenytoin or oxacillin
Lipids are soluble in alcohol
Temporary non-tunneled central catheter
Quick access device placed in emergencies or in ICUs
* Triple lumen subclavian, percutaneous, acute-care catheter, CVP
* Short term: 7-10 days
* Not for home use
