Central Venous access devices (Complete) Flashcards
What are CVADs?
Catheters placed in large blood vessels such as the subclavian vein and jugular vein
CVADs stand for Central Venous Access Devices.
What are the three main types of CVADs?
- Centrally inserted catheters
- Peripherally inserted central catheters
- Implanted ports
What is the primary purpose of CVADs?
Permit frequent, continuous, rapid, or intermittent administration of fluids and medications
What types of drugs can be administered through CVADs?
Drugs that are potentially vesicants, blood/blood products, and parenteral nutrition
Who are CVADs particularly useful for/ Common indications
Patients with limited peripheral vascular access or need for long-term vascular access
-Hemodynamic monitoring
-Venous blood samples
-Injection of radiopaque contrast media
What are two advantages of using CVADs?
- Immediate access
- Reduced venipunctures
- Decreased risk of extravasation
What are two disadvantages of using CVADs?
- Increased risk of systemic infection
- Invasive procedure
Describe a centrally inserted catheter.
-Inserted into a vein in the chest or abdominal wall with tip resting in distal end of superior vena cava
-Nontunneled or tunneled
What is the purpose of the Dacron cuff in a tunneled catheter?
Anchors catheter and decreases incidence of infection
What are examples of long-term tunneled catheters?
- Hickman
- Broviac
- Groshong
(can be single, double, or triple lumen)
What does a PICC stand for?
Peripherally inserted central catheter
-Single or multi-lumen, nontunneled
Pink bracelette
What is the duration of use for a PICC?
For patients who need vascular access for 1 week to 6 months
*Cannot use arm for BP or blood draw
What are two advantages of using a PICC?
- Lower infection rate
- Fewer insertion-related complications
- Decreased cost
What are two complications associated with PICCs?
- Deep vein thrombosis
- Phlebitis
What is an implanted infusion port?
Central venous catheter connected to an implanted, single or double subcutaneous injection port
Drugs are injected through skin into port
What materials can the port of an implanted infusion port be made from?
- Titanium
- Plastic
With self-sealing silicone septum
What is a key advantage of implanted infusion ports?
-Good for long-term therapy
-low risk of infection
-Cosmetic discretion
What are midline catheters?
Peripheral catheters 3 to 8 inches long, single- or double-lumen
(Use and care similar to PICC)
How long may midline catheters stay in place?
Up to 4 weeks
What is a potential complication of CVADs related to catheter occlusion?
-Clamped or kinked catheter,
-tip against wall of vessel, -thrombosis,
-precipitate buildup in lumen
What can cause an embolism in relation to CVADs?
-Catheter breaking,
-dislodgement of thrombus,
-entry of air into circulation
What can lead to infection in CVADs?
Contamination during insertion or use, migration of organisms along catheter, immunosuppressed patient
SCRUB THE HUB
What is a serious complication related to CVAD
Pneumothorax
-Perforation of visceral pleura, Catheter migration due to
-improper suturing,
-trauma, forceful flushing,
- are spontaneous
What is important for maintaining patency of a PICC?
Flushing is important with normal saline prefilled syringe using only a 10 mL syringe or larger
Flush before and after
What is the preferred cleansing agent for changing CVAD dressings?
Chlorhexidine
What should be done when removing a CVAD?
Gently withdraw while patient performs the Valsalva maneuver and apply pressure with sterile gauze
-Apply antiseptic ointment and sterile dressing
What must be ensured when removing a CVAD?
That the catheter tip is intact
Nursing Management (general)
-Inspect catheter and insertion site
-Assess for pain
-Change dressing and clean according to institution policies
-Clorhexidine and transparent semipremeable dressing or gauze dressing
Nursing management (cleaning)
Change injection caps
-Have patient turn head to opposite side
-Valsalva if no clamp
Flushing is important
-Normal saline prefilled syringe
-Use only 10 mL syringe or larger
-Push-pause technique
