Central venous access devices

Question 1

What is a CVAD?

Answer 1

-Cathater placed in large blood vessels (subclavian vein, jugular vein)

3 main types

• centrally inserted catheters
• peripherally inserted catheters
• Implanted ports

Question 2

What is the point of a CVAD?

Answer 2

• to administer frequent, continuous, rapid, or intermittent fluids/meds
• allow for giving drugs that are potentially vesicants
• used to administer blood/blood products and parenteral nutrition

For patients with limited peripheral vascular access or need long term vascular access

Question 3

Centrally inserted catheter

• where?
• types?

Answer 3

• Inserted in vein in chest or abdominal wall with tip in superior vena cava
• nontunneled or tunneled
• Dacron cuff anchors catheter and decreases insidence of infection
• single, double, or triple lumen
• Hickman, Broviac, and Groshong are all examples

Question 4

Picc
What is it?
Types?
-For who?
Advantages?
Complications

Answer 4

• Central venous catheter inserted into arm vein
• single or multi lumen –> non tunneled
• for ppl who need vascular acces for 1 week to 6 mnths
• low infection, fewer insertion issues, cheaper
• deep vein thrombosis, phlebitis, can’t use arm for BP or blood draw

Question 5

Implanted infusion port
what is it?
what is it made of?
how does it work?
advantages?

Answer 5

• central venous catheter connected to implanted single or double subcutaneous injection port
• made of titanium or plastic with self-sealing silicone septum
• drugs are injected thru skin into port
• good for long term, low infection, cosmetic discretion

Question 6

Midline catheter
what?
how long in place?

Answer 6

Peripheral catherers: 3-8 in long; single or double lumen
-use and care simlar to PICC

Can stay in place up to 4 weeks

Question 7

5 complications of CVADs

Answer 7

Catheter occlusion
-clamped or kinked; tip against vessel wall, thrombossis; precipitate build up

Embolism
-catheter breaking; dislodgement of thrombus; entry of air into circulation

Infection

• contamination during insertion or usse
• migration of organisms along catheter
• immunosuppressed patient

Pneumothorax
-perforation of visceral pleura

Catheter migration

• improper suturing
• trauma or forceful flushing
• spontaneous

Question 8

Steps to manage a cvad

Answer 8

• inspect catheter and insertion sight (check x-ray)
• assess for pain

change dressing and clean

• transparent, semipermeable dressing or gauze
• chlorhexidine preferred cleansing agent

change injection caps

• turn patients head opposite way
• valsalva if no clamp

Flushing is important
-normal saline prefilled syringe
-only use 10 mL or bigger syringe
push-pause technique

Question 9

Remoing CVADs

Answer 9

gently withdraw while patient performs valsalva maneuver
apply pressure with sterile gauze
ensure catheter tip is intact
apply antiseptic ointment and sterile dressing