Central Vascular Access Devices (CVAD) Flashcards
Define CVAD
A catheter that is inserted into a peripheral or central vein and the distal tip is positioned in the lower third of the superior vena cava (SVC)
What are the 6 reasons for CVAD placement?
- repeated access to vein
- administration of highly irritating solutions
- monitoring
- long term therapy
- poor venous access
- hemodialysis
What are the 4 types of CVAD?
- Percutaneous non-tunneled catheters
- Subcutaneously tunneled catheters
- Peripherally inserted central catheters (PICC)
- Implanted subcutaneous ports
What is the difference between open and closed ended CVAD?
Open ended does not have a valve and the end of the catheter is open like a straw–requires clamping when not in use
- increased risk of occlusion and air embolism
Closed ended has a valve and the end of the catheter has a slit on the side that opens with positive pressure–does not require clamping
Describe a percutaneous non-tunneled catheter
- Inserted through neck or chest wall into internal jugular, subclavian, or femoral vein & is sutured in place
- used in emergency situations
- short term
- short length
- large gauge
- highest rate of infection
Describe a subcutaneously tunneled catheter
- Implanted through a subcutaneous tunnel from the subclavian vein down the chest wall & exits at nipple level
- inserted by a physician in the OR
- designed for long term use (years)
- long length
- large gauge
- have a small cuff which stabilizes/anchors
- lower rate of infection
- great for active people
Describe a peripherally inserted central catheter
- inserted through the basilic or cephalic vein close to the ACF
- most common
- inserted at the bedside by nurses who have additional special training
- long term (months)
- long length (18-24”)
- smaller gauge
- often secured with stabilization or securement device
- high incidence of catheter related infection and occlusion
- measure & document external length of the catheter with each dressing change
- can have a valve or no valve
Describe an implanted subcutaneous port
-inserted into the subclavian or IJ vein, attached to a reserviour that is surgically implanted in a subcutaneous pocket on the chest wall
- inserted by a physician in an OR setting
- least interference with ADLs
- lowest rate of infection
- accessed using a specialized non-coring needle
- push the non-coring needle through the skin and silicone gel until you hit the rigid back of the port (like sticking a needle into a rubber eraser)
- confirm the placement by checking for blood return in the syringe
- long term therapy (years) (example: 20 years)
- can be single or double lumen
What are the different types of thrombotic occlusions?
- a fibring sheath is a clot covering the end of the catheter like a sock
- intraluminal clot forms inside the catheter lumen and plugs it
- fibrin tail or flap is where the flap opens when infusing something, but the clot interferes when aspirating
- mural thrombus is where thrombi form all around the exterior of the catheter
What is a CRBSI / CLABSI?
- sepsis that occurs secondary to a CVAD (terms used interchangeably)
Describe the correct way of flushing a CVAD
- helps maintain patency
- flush before and after med/blood/intermittent therapy or as part of maintenance if not in use
- use 10mL of NS (20mL or NS after drawing blood)
- use only a 10mL or larger syringe size for correct pressure
- push/pause
What does “A SASH” stand for?
- Aspirate
- Saline
- Administer
- Saline
- Heparin
for locking CVAD if required
How often should you change a CVAD dressing?
- initial dressing changed at 24 hours post insertion
- transparent dressing changed every 7 days and prn
- gauze dressing changed q48h
