Central Vascular Access Devices

Question 1

what is a CVAD?

Answer 1

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.

Question 2

guidelines for CVAD needs include

Answer 2

• long term IV therapy (>6days)
• TPN with D10 or higher
• vesicants
• meds or solutions with extreme pH or osmolarity

Question 3

goal of CVADs

Answer 3

“Deliver safe, efficient therapy that maximizes the patient’s quality of life, with minimal risk of complications”

Question 4

CVAD planning includes

Answer 4

Asessing health problems, patient preference, purpose

• planning with multidisciplinary team, pt, and family
• ongoing assessment for need, and site assessment for complications

Question 5

properties

Answer 5

-can have more than one lumen
-may be open ended or closed ended
may be for short or long term therapy

Question 6

3 types of ports in multi-lumen catheters

Answer 6

proximal
medal
distal

Question 7

proximal lumen

Answer 7

• draw blood- not contaminated by meds

- closest to injection site

Question 8

medial lumen

Answer 8

-give meds

Question 9

distal lumen

Answer 9

• thick, vesicant meds

- closest to the heart; open last

Question 10

open ended CVAD

Answer 10

• 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

Question 11

close ended CVAD

Answer 11

• 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

Question 12

four basic types of CVADs

Answer 12

• centrally inserted venous catheter
• tunneled catheter
• implanted port
• peripherally inserted central catheter (PICC)

Question 13

where is the CIVC usually placed?

Answer 13

percutaneously through the subclavian, femoral, or jugular vein, and threaded into the SVC.
medically placed
-used for short term than PICC or tunneled

Question 14

Adv and Disadv of CIVC

Answer 14

Adv: -inserted at bedside, safe for all fluids and blood draws
Disadv- highest risk of infection, not for outpatient use, short term use

Question 15

tunneled catheter

Answer 15

• 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

Question 16

Adv ad Disadv to tunneled catheters

Answer 16

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

Question 17

how is an implanted port, well implanted?

Answer 17

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

Question 18

Implanted port advantages

Answer 18

• can remain for many years
• requires no daily maintenance
• maintains body image and mobility
• low infection rate
• safe for all fluids and blood drawing

Question 19

disadvantages to the implanted port

Answer 19

• more difficult and expensive insertion in angiography suite
• minor insertion discomfort
• difficult removal
• minor discomfort with needle access

Question 20

PICC lines

Answer 20

• inserted by an ARNP, physician, or specially trained RN
• access through the brachial, cephalic, or basilic vein
• Regular or powered

Question 21

Power PICCs

Answer 21

-pressure-activated safety valve PICC have built in valve in hub

Question 22

What size syringe should you use to flush a PICC line? Any special techniques? What kind of pressure should you maintain?

Answer 22

10-12 mL syringe

• Use a pulsating technique, push pause
• maintain positive pressure

Question 23

ASASH?

Answer 23

A-aspirate
S-saline flush
A- administer med
S- saline flush
H- heparin if indicated

Question 24

When is it okay to use a CVAD?

Answer 24

after the placement has been verified

Question 25

insertion complications

Answer 25

• catheter malposition
• arterial puncture
• catheter embolism
• air embolism
• pneumothorax (popped lung)

Question 26

signs of air embolism

Answer 26

chest pain
cyanosis
increased BP and/or PR

Question 27

how to prevent an air embolism

Answer 27

• trendelenberg position during insertion
• keep catheter capped when not in use
• always expel air from syringe prior to administration
• do not allow IV fluids to run dry

Question 28

catheter malpostion/ migration

Answer 28

• measure and document the external length on the insertion and with each dressing change.
• displacement into the right atrium can cause tachycardia or arrhythmias
• infusing fluid into the pericardial sac can cause cardiac tamponade (heart collapse- could be from central line poking hole in heart and fluid seeping into the pericardial sac)

Question 29

Port-insertion complications

Answer 29

• catheter occlusion - maintain positive pressure on syringe plunger during withdrawal (open-ended catheters) -may require cot-dissolving therapies
• catheter damage- avoid sharp instruments; no excessive pressures (use 10-12cc syringe for flushing)