Central Venous Access Devices Flashcards
What are the different types of CVAD?
- Non-tunneled catheters
- Tunneled catheters
- Implanted vascular devices
- Peripherally inserted central catheters (PICCs)
Non-tunneled catheter location
- Placed in central vein via subclavian or internal jugular vein
- In peds can be placed in groin in PICU setting
Tunneled catheter location
Under the skin then threaded into a central vein
Implanted vascular device location
Device under the skin with catheter into a central vein
PICC location
Threaded through a peripheral vein into the central circulation/vein
CVAD indications
- Infusion of concentrated solutions: TPN of [Dextrose/Glucose] > 15-25%
- Vasoactive medications such as dopamine and dobutamine
- Blood products - generally over longer term or larger volumes quickly - often in emergency situations
- Poor or limited peripheral venous access i.e., for longer term antibiotics or blood draws
- Long-term medication or chemotherapy/other vesicant or irritating solutions
- Hemodialysis - generally short term
What is the maximum concentration of dextrose that can be infused peripherally?
12.5%
What happens with negative pressure in a Groshong catheter?
Negative pressure opens valve inward permitting blood aspiration
What happens with positive pressure in a Groshong catheter?
Positive pressure opens valve outward allowing infusion
What happens with neutral pressure in a Groshong catheter?
At neutral pressure valve remains closed, reducing risk of air embolism, blood reflux, and clotting
Do closed-ended catheters require heparin?
No!
Uses for non-tunneled catheter
- To administer large volumes and multiple fluids
- Vasoactive medications, antibiotics, blood products, TPN
- Obtain blood samples
What should always be done before using a central line after it has been placed?
Obtain a chest x-ray to confirm placement of catheter
Indications for PICC lines
- Kept of longer periods of time
- Antibiotics
- Hydration
- Pain management
- Infusion of hyperosmolar/hypertonic fluids
- Hyperalimentation (TPN)
- Some types of chemotherapy
- Continuous home inotropic therapy (milrinone, dobutamine)
Advantages of PICCs
- Useful for acute care and home care
- Permits freedom of movement
- Small, flexible, useful in young or elderly
- Used to administer fluid and blood draws (if lumen large enough)
Indications for dialysis catheter
- Acute renal failure
- Overdoses
- Need maturation of a dialysis fistula or graft
- Use as a bridge during transplantation
- Permanent access in those patients who have been depleted of dialysis sites
Disadvantages of dialysis catheters
- Hard to maintain over a long time frame
Indications for IVAD (Medi-Port)
- Access site for obtaining blood samples
- Cyclic therapies such as chemotherapy, antibiotics
- Treatments for chronic or long-term illnesses, such as cancer or cystic fibrosis
Advantages for IVAD
- Can handle both bolus injections and continuous infusions
2. Can draw blood from
Who can access an IVAD?
Certified nurses
Advantages of tunneled catheters
- Provides stability
2. May protect against endovascular infection from the skin
Indications for tunneled catheters
- Chemotherapy
- Long-term nutritional support
- Long-term or intermittent therapies
Complications of CVACs
- Thrombosis
- Infection
- Air embolism
Signs/symptoms of thrombosis
- Swelling, warmth, tenderness of extremity beyond insertion site
- Cyanosis of face
- Development of collateral (extra) vessels
Note: diagnosis is made by ultrasound, venogram, or CT angiography
Infection
Fever, increased WBC, erythema, tenderness at catheter site, purulent drainage
What is an acute infection of a CVAC and what is the common cause?
Occurs 3-5 days after insertion often due to contamination during the insertion procedure
What is a delayed infection of an CVAC and what is the common cause?
An infection that occurs more than 5 days after central access device placement commonly caused by staph. aureus.
What are the signs/symptoms of an air embolism?
- Respiratory distress
- Increased heart rate
- Cyanosis
- Decrease in blood pressure
- Sudden change in LOC (often first indicator that something is wrong)
- Back or shoulder pain
- Churning murmur over precordium
What should you do if there is an air embolism?
- STAY WITH PATIENT
- CALL FOR HELLP
- Administer oxygen
- Pinch off catheter if still in place
- Cover any open of disconnected catheter ports
- Place patient on left side in Trendelenberg position (helps keep air in right atrium)
How should you care/manage central lines?
- Care by “bundle” aspects
- Daily assessment
- Aseptic technique
- Maintain an occlusive dressing
- Minimize breaks in lines/maintain patency
- Vigorous scrubs of all hubs
- Timely tubing changes
How often should you change the dressing of a central line?
- Whenever the dressing is loose, wet, or non-occlusive
2. Otherwise, every 7 days if covered by Tegaderm
What size syringe should you use with a central line?
10 mL or larger
