Central Venous Access Flashcards
Patient selection
Short or long-term therapy (anybody >5 days needs CVA of some sort).
Blood sampling (poor vascular access and frequent blood draws).
Multiple therapies.
Venous access sites.
Vesicant administration.
In order for something to be a CVAD, despite where if enters the body, the tip of the catheter must sit in the lower 1/3 of the _______ at the caval-atral junction.
Superior vena cava
Pediatric catheter insertion sites
Temporal or auricular, but otherwise same vascular access as adults just use small catheters
Classifications of CVA catheters
1) Central venous catheters- tunneled or non tunneled
2) ports
3) Peripherally inserted central catheters
Nontunneled catheters
Subclavian catheter. Jugular placement possible too. Short-term device intended to be used for several days and primarily placed and used in an acute care setting. Single-or multiple-lumen.
Epidural catheter
When cleaning, cannot use anything with alcohol in it. Alcohol can leak along the tract. Non-permanent or permanent (tunneled). Pain relief. Always have to have a filter.
Tunneled catheters
Hickman, Broviac, Groshong. Need for prolonged CVA and a method to decrease potential infection from the skin exit site. Considered long-term catheter for pts who require lifelong or long-term infusion therapy such as PN or chemo. Under muscle into vessel (subclavian).
Hickman catheter
Single, double, triple, quad lumens. Open-ended cath. Flushed daily. Need to be clamped (“clamp here” area).
Broviac catheter
Size of line in body smaller than in hickman. Flush daily. Peds or small people
Groshong catheter
Have valves- if not in use, closed. Infusing, open out. Drawing in, open in. Don’t need heparin. Good flushing! Every 7 days. Only flushed when used=decrease cost
Ports
Kids, breast/colon cancer, meds every 4-6 weeks. Under skin- make pocket, thread thru skin to subclavian vein then SVC. Access with Huber needle (noncoring needle). Long-term. Single and double lumen. Only accessed and flushed every 4-6 weeks. Under skin so no care when not accessed. Sutured to rib. Deaccess and reaches making sure you are at a 90 degree angle to the port, not a 90* angle to the pt, and you feel the back of the port.
Power port
Use for injection of dye for MRI, CT. Forces in so it dissipates quickly. Can handle the force of fast injection of the material. Knobs to access landmarks. Triangular. Need to wear an armband, have a wallet card for identification of it. Not to be used to administer other medications. Purple=power
Never give anything in a catheter that you cannot easily withdraw ___ to ___ mL of blood because you do not have a patent catheter
3-5
90% of VADs today. Best place to put is on the right side because there is a steeper angle on the left side and it can injure the vessel wall. Preferred place is basilica vein. Designed for infusion therapies extending beyond 6 days to several months.
PICC (peripherally inserted central catheter).
Want catheters in a vessel large enough to _____ whatever you are giving and to minimize damage to the vessel wall
hemodilute
