Central Vascular Access Devices Flashcards
what is a CVAD?
a vascular access device which is inserted into a central vein and terminates in the superior or inferior vena cava just above the right atrium.
guidelines for CVAD needs include
- long term IV therapy (>6days)
- TPN with D10 or higher
- vesicants
- meds or solutions with extreme pH or osmolarity
goal of CVADs
“Deliver safe, efficient therapy that maximizes the patient’s quality of life, with minimal risk of complications”
CVAD planning includes
Asessing health problems, patient preference, purpose
- planning with multidisciplinary team, pt, and family
- ongoing assessment for need, and site assessment for complications
properties
-can have more than one lumen
-may be open ended or closed ended
may be for short or long term therapy
3 types of ports in multi-lumen catheters
proximal
medal
distal
proximal lumen
- draw blood- not contaminated by meds
- closest to injection site
medial lumen
-give meds
distal lumen
- thick, vesicant meds
- closest to the heart; open last
open ended CVAD
- open at the distal tip
- no valve, blood enters catheter when there is no infusion
- risk of air embolism or hemorrhage if disconnected
- requires clamping with exit from the system
- requires periodic flushing
- any type of CVAD can be open ended
close ended CVAD
- valve present at tip of the catheter or proximal at hub
- clamping not required
- valve is closed except during infusion or aspiration
- heparin not needed for patency
- any type of CVAD may be close ended
four basic types of CVADs
- centrally inserted venous catheter
- tunneled catheter
- implanted port
- peripherally inserted central catheter (PICC)
where is the CIVC usually placed?
percutaneously through the subclavian, femoral, or jugular vein, and threaded into the SVC.
medically placed
-used for short term than PICC or tunneled
Adv and Disadv of CIVC
Adv: -inserted at bedside, safe for all fluids and blood draws
Disadv- highest risk of infection, not for outpatient use, short term use
tunneled catheter
- inserted in OR or interventional radiology
- exits skin via subq tunnel
- dacron cuff on the tunneled portion anchors catheter in place & acts as infection barrier
Adv ad Disadv to tunneled catheters
Adv- good for intense, long term & frequent IV therapy
-safe for all fluid and blood draws
Disadv- inserted in angiography suite, causes minor insertion discomfort, requires self care for dressing changes and flushes
how is an implanted port, well implanted?
surgically implanted in a subq pocket
-contains a self-sealing injection port with a catheter attached
catheter is threaded into the subclavien vein and SVC.
-up to 2000 punctures
- Huber needle- 90 degree angle needle
covered with transparent dressing for infusions
-ALWAYS ASPIRATE
Implanted port advantages
- can remain for many years
- requires no daily maintenance
- maintains body image and mobility
- low infection rate
- safe for all fluids and blood drawing
disadvantages to the implanted port
- more difficult and expensive insertion in angiography suite
- minor insertion discomfort
- difficult removal
- minor discomfort with needle access
PICC lines
- inserted by an ARNP, physician, or specially trained RN
- access through the brachial, cephalic, or basilic vein
- Regular or powered
Power PICCs
-pressure-activated safety valve PICC have built in valve in hub
What size syringe should you use to flush a PICC line? Any special techniques? What kind of pressure should you maintain?
10-12 mL syringe
- Use a pulsating technique, push pause
- maintain positive pressure
ASASH?
A-aspirate S-saline flush A- administer med S- saline flush H- heparin if indicated
When is it okay to use a CVAD?
after the placement has been verified
