central venous access devices

Question 1

what is an acute central catheter?

Answer 1

it is a kine to infuse medicines to critically ill patients
can be done over several hours
and can infuse several drugs in and that have no reactions or lack of compatibility

Question 2

which lines have clamps?

Answer 2

open ended lines means you are able to close the line when they are not in use

Question 3

what are the different types of Hickmans catherter?

Answer 3

single , double or triple lumened

Question 4

why is Hickmans better than ACC?

Answer 4

its more robust so it can last for several years as Long as it doesn’t get infected.
- has a larger diameter the ACC so can collect blood or do haemodialysis

Question 5

what are some of the care points with Hickmans?

Answer 5

it is tunnelled
have to flush with heparinised saline twice a week even if its not in use.
If a medicine is going down the line flush with 5mls between each drug and then 10mls if finished

Question 6

how is hickmans inserted?

Answer 6

it inserted by radiology in anaesthertics room as the patient is given anaesthetic.
inserted into the internal jugular and is tunnelled under the skin with a trichina needle

Question 7

how do you take blood with hickmans?

Answer 7

do a push pull technique so no blood sits in the lumen of the catheter or goes down another line
flush with 20mls of saline after

Question 8

where is the entry site of a hickmans line ?

Answer 8

it is the internal jugular

Question 9

where is the exit sit of a hickmans line?

Answer 9

chest

needs more care and flushing due to infection

Question 10

why is a suture needed around the hickmans line?

Answer 10

it stays with he patient for 21 days so that the cuff on the line has time to be fibrosesd to the normal body tissue

Question 11

how is a hick mans line removed?

Answer 11

it has a cuff called the Dacron cud which you make an incision above to release the line

Question 12

what are some of the features of Piccs

Answer 12

its acute and tunnelled
its more delicate and looks robust
has a single dual lumen

Question 13

how are PICCs inserted?

Answer 13

peripherally inserted central line goes into a large vein in the arm below or above the anticubital fossa

Question 14

how long can PICCs stay in ?

Answer 14

can stay in for weeks or months , no longer than one year

Question 15

how are PICCs valves made?

Answer 15

they are made form silicon and close lines don’t need a valve at the end but open lines do

Question 16

How are PICCs held in place

Answer 16

by a stack lock which is changed once a week or a secured curve which goes in at the time of insertion and stay in place for the lines duration

Question 17

How do closed lines open

Answer 17

they open with positive pressure allowing fluid in and out

Question 18

what are implanted ports?

Answer 18

titanium or strong silicone in the arm or chest wall

and are inserted in radiology or surgery

Question 19

what is a disadvantage of implanted ports?

Answer 19

• cannot do strenuous sports as the line could be moved
• not recommended but you can go swimming
• blod clots but this can be tackled with a endoxcoating

Question 20

which vein is best for a CAVD?

Answer 20

Internal jugular is most common
femoral - infections 
subclavian 
basilic - arm 
cephalic - arm 
brachial - arm

Question 21

where is a CAVD located?

Answer 21

tip of the CAVD is in the lower third of the SVC, close to the junction of the SVC and right atrium

Question 22

what the advantages of CAVD ?

Answer 22

• continous venous acess
• can do blood sampling
• avoids the constant need for vein puncture or peripheral cannulation
• allos for drugs , blood products , parenteral nutrition and chemotherapy

Question 23

what is the disadvantages of a CAVD?

Answer 23

-pneumothorax
-haemothorax
- restrictions to daily life
- need to commute to the hospital
- infection risk
thrombus risk
- catheter air embolus
- haemorrhage
- nerve damage