CVAD Flashcards
CVAD stands for
Central Venous Access Device
With a CVAD you can administer what types of fluids/products
IV fluids, blood products and medications
The tip of the CVAD sits in the ________ or ________
Superior or Inferior Vena Cava
What 3 veins can the CVAD be inserted
internal jugular (IJ), subclavian vein, femoral vein or brachial vein. If femoral = more chance of infection
Another way CVAD can be placed
under the skin (aka port)
After placing CVAD - first thing you should verify_______ via_________
location of the tip via a chest xray (magnet)
One exception to verifying placement
if placed under fluoroscopy
What is Fluoroscopy?
imaging technique that uses X-rays to obtain real-time moving images of the interior of an object.
How long can CVADS remain in place (depending on the type)
several weeks to months
Who can benefit
those requiring long term IV treatments
What should you avoid giving in CVAD_______ or flushing with smaller syringe (< 10 ml) due to ____________
medications
may result in too much pressure = rupture of catheter
Some reasons to use CVAD
parenteral nutrition
chemo/other irritating (vesicant) solutions
Blood products
antibiotics
when peripheral access is limited
CVP (central Venous pressure) monitoring = fluid overload
Hemodialysis
What is the lumen of a catheter
hollow channel within a tube
Can you have more than one lumen?
Yes, single, multiple - up to 5
If you have single lumen and giving parenteral nutrition - what can’t you do?
use to sample or transfuse blood - as blood tends to stick to tubing - makes nutrition hard to flow
Names of ports of the lumen
proximal, medial distal
Type of catheters
Short
midline
PICC - Peripheral inserted central catheter
Non-tunneled percutaneous catheter (CVC)
Tunneled catheters
implanted ports
hemedialysis catheters
Short - how long?
3/4 - 1 1/4 inch
Short gauge?
26 (smallest) - 14 (largest)
Short timeframe in and when to assess
no specific (policy) and Q 4 hours minimum
Midline - how long
3-8 inches, 3-5 French and can be double or single
Midline - where placed
upper arm
midline used for
hydration and drug therapy
Midline time in
used when needed for up to 6 days and UP TO 14 DAYS!!!
Midline - do not use to
vesicant drugs, parenteral nutrition, draw blood
PICC means
Peripherally Inserted Central Catheter - LONG
PICC is inserted
into basilic (preferred) or cephalic vein in arm
PICC line ends
in the superior vena cava just above the right atrium - BAD IF IN ATRIUM - higher risk of thrombosis
PICC - single or multiple lumens? Color is
yes, can be both
purple
Gold standard placement verification for a PICC
3CG technology - magnetic tracking - CAN ONLY USE IF PT IS IN NORMAL SINUS RHYTHM
Don’t use 3CG technology (magnet tracing) for PICC placement if
pt is not in NSR - normal sinus rhythm
PICC indicated for
IV fluids, medications, blood and blood sampling - great for home IV treatments
In arm with PICC - DO NOT
take BP, draw blood or any injections
Greatest risk to pt with PICC
DVT and infection
Non tunneled Central Venous Catheter - what makes it non tunneled?
It goes directly to vein and is not put under skin prior to the insertion point
Where are Non tunneled Central Venous Catheters placed
subclavian in upper chest or jugular vein into Superior Vena Cava or less often femoral then Inferior Vena Cava
Non tunneled duration_______ due to _____
short term due to high rate of infection (2 weeks) (access is direct to vein = bacteria)
Tunneled central venous catheters - what makes them tunneled?
portion lies in a subq tunnel on skin
What does tunneled have which helps reduce infection?
cuff with antibiotic at skin insertion
when is tunneled used
frequent long term infusion
why not just use a PICC instead of tunneled?
if someone uses there arms a lot - paraplegic
What is a portacath?
device implanted under the skin - appears as a bump
Implanted ports are most often used for_________ because of compromised immune system
chemo
Is any of the catheter outside of body with portacath?
no - all under skin - port is self sealing
How is portacath accessed?
Huber needle - a non coring/non barred needle - it is curved so it does not go through port
How many times can you access portacath with same needle?
about 7 days
Portacath - after accessing and prior to each use:
aspirate for blood return
flush with 10 ml NS
Portacath - prior to deacessing, removing the needle
lock with heparin solution (per policy)
flush with NS
Largest catheters
hemodialysis
common complication for hemodialysis catheter
CLABSI = central line associated blood stream infection AND vein thrombosis
Who can access
only trained Hemodialysis nurses
Change hemodialysis dressing
Q 48 hours/with treatment/when soiled
Most common infection with CVADS
staph aureus, yea and fungi
what to monitor for infection
fever, redness, swelling, drainage, pain, chills
How to prevent infections
proper technique - be sure draping and gloves are sterile,
wear gown and mask - everyone in room
hand hygiene
prepare insertion site with chlorhexidine and alcohol
Scrub the hub with alcohol at least 15 sec
dressing changes
access necessity daily (do they need it)
watch for early signs of infection
Possible complication with CVADS
air embolus with discontinuation or when opened
CVAD dressing changes mandate the use of
sterile technique
Change CVAD dressings Q
7 days/hospital policy
What to ask patient with catheters
allergies to chlorohexidine gluconate and latex
New insertion of CVAD requires all new
tubing and fluids
After completion and prior to shift
LABEL tubing, dressing and IVF and check them at start of shift!!
What do to if no label?
change
Cath often used with long term hemodyalisis patients
tunneled - fistula healing can take up to 6 mo
