Central Venous Access Device

Question 1

What do Central Venous Devices do?

Answer 1

Allow the administration of IV fluids, blood products, and medications

Question 2

Where are CVADs inserted?

Answer 2

Into large veins including:
-internal jugular veins
-subclavian vein
- brachial vein
-femoral vein
-can be implanted under the skin

Question 3

Where does the tip of the CVADs sit once inserted?

Answer 3

The superior or inferior vena cava

Question 4

Unless placed under fluoroscopy, what confirms placement of CVADs?

Answer 4

Tip placement confirmed with a x-ray (before use)

Question 5

How long can CVADs remain in place?

Answer 5

Depending on type, several weeks to months (beneficial for Pt.’s with chronic diseases and require long-term intravenous therapy)

Question 6

What are CVAD indications?

Answer 6

In general=
-Parental nutrition
-chemotherapy (or other vesicant or irritating solutions)
-blood products
-IV medications or solutions (peripheral access is limited)
-Central venous pressure monitoring
-Hemodialysis

Question 7

Single-lumen CVAD uses

Answer 7

-infusions into large, central veins
-if using for prenatal nutrition infusion, cannot be used to sample blood/ transfuse blood (blood cells adhere to lumen impeding nutrition flow)

Question 8

What is a lumen?

Answer 8

A hollow channel within a tube

Question 9

Multi-lumen CVAD uses

Answer 9

-increases advantages of a single-lumen
-separate color-coded ports to ID different lumens (distal end/ various areas)
-solutions do not mix, so several treatments can be performed in a single CVAD insertion site
-can have 2-5 lumens

Question 10

Ports and CVADs types/ usages

Answer 10

-distal lumen-blood/ viscous fluids
-middle lumen-parental nutrition
-proximal lumen-administer Rx/ blood
*check manufacturers/ facility procedures instructions for lumen labels/ accurate usages per lumen type

Question 11

What are the four general types of CVADs?

Answer 11

-nontunneled CVAD
-tunneled CVAD
-Peripherally inserted central catheter (PICC)
-Implanted venous port

Question 12

Type of CVAD being used is determined by what factors?

Answer 12

-Length of time & therapy

Question 13

Nontunneled CVADs risk for infections

Answer 13

-short term use (greatest risk for infection)
-can be inserted into femoral veins, but increases risk for infection
-Infection risk; protrudes externally/ no subcutaneous tunneling
-Assess daily for need and potential removal (reduce risk for catheter-associated bloodstream infection)

Question 14

Nontunneled CVAD insertion and uses

Answer 14

-At bedside/ emergency setting, does not required sedation by percutaneous venipuncture
-most commonly in internal/ or subclavian vein, tip sits in superior vena cava
-indications= IV therapy, blood sampling, venous pressure monitoring

Question 15

Associated risks for nontunneled central venous catheter.

Answer 15

-High risk of infection
-venipuncture directly above lungs increases risk of pneumothorax

Question 16

Tunneled catheter uses
(Brand names: Hickman, Broviac, Groshong catheter which differs slightly in lumen construction/ size)

Answer 16

-long term Tx/ considered permanent
-administering fluids, chemotherapy, antibiotics, blood, parental nutrition, central venous pressure monitoring, blood sampling

Question 17

Tunneled catheter facts

Answer 17

-inserted under the skin (chest region)> threaded into large vessel (possibly subclavian vein)>tip rest in superior vena cava
-Dacron cuff (within subcutaneous tunnel and insertion of dermis where enters the blood stream)