CVAD Flashcards
what is a CVAD (central venous access device)
- intravenous cather or infusion port
- designed to administer medications, nutrients/IV fluids, blood products and other viscous fluids through central vein
- 1 catheter: multiple lumens/gauges/exits
– distal: blood draw, blood infusions, meds, CVP
– proximal: IV fluids, meds, blood draw
– medial: TPN - inserted into large veins in central circulation with catheter tip ending in superior vena cava
- x-ray confirmation
(distal, proximal and medial are just how close the exit is to the heart,
larger gauge would be used for thicker products like blood, TPN (parenteral nutrition) = 18 gauge,
don’t get hung up on which products go in distal, proximal and medial bc not hard and fast rule)
indications for CVAD
- peripheral access (in arms) not available or contraindicated
- for moderate to long-term use (not just 2-3 days)
- need for multiple intravenous access
- hemodialysis
- total parenteral nutrition (TPN)
- chemotherapy
- multiple blood transfusion/blood draws
- long term antibiotics/IV medications or solutions (not basic IV meds, more serious)
- central venous pressure monitoring
(CVAD is umbrella term for jugulars, subclavians, PICC lines, ports, central lines)
preparing the patient
- tell them the purpose: what will be administered (meds, IV, fluids, etc.),
- tell them estimated length of time
- teach what to avoid and why (not to tug and pull on it, sutures stay intact, don’t get dressing wet, edges of dressing stay sealed)
- pt should report pain, tenderness, s/s infection
- schedule of care is every 7 days or as needed, describe how replace dressing
- post removal and care: prepare pt/family when appropriate
CVAD insertion: pre and post protocols
- Dr’s order and signed consent
- support for patient/family: what to expect in the room, etc.
– surgical asepsis - pre and post vital signs/assessments
- pt in trendelenburg position (head down, feet up, to prevent air embolism)
- standby assist for physician/PICC team
- x-ray confirmation
- documentation by both parties
types of CVAD
- non-tunneled
- tunneled
- port-a-cath
non-tunneled
- inserted directly into subclavian (most common), jugular, femoral or peripheral vein (peripherally inserted central catheter = PICC line)
- secured by sutures outside the insertion site to the skin
- acute, moderate term = 6 weeks
- higher infection rate than tunneled bc more open to air
- nurse can discontinue
peripheral inserted central catheter (PICC)
in peripheral vein
- basilic or cephalic vein, if peripheral vein can be accessed
- PICC team of IR insertion
- no phlebotomy or blood pressures in the arm with the PICC (don’t do another stick on arm with PICC line)
- tend to clot easier
tunneled CVAD
- surgically tunneled beneath the skin
- unique due to Dacron cuff on the catheter
– cuff is sutured in place (subq tissue) initially then scar tissue secures itself around the cuff
– Dacron cuff helps secure, prevent infection - common sites: subclavian, vein, IJ
– can also be placed in femoral vein - chronic, long term, greater than 6 weeks
- multiple ports
- nurse cannot discontinue; must be surgically removed bc of Dacron cuff
(used for much longer term,
done in interventional radiology, not by PICC team bedside,
brown - distal, 16g
blue - medial, 18g
white - proximal, 18g
Dacron, Groshong, Hickman/Broviac are types)
implanted port
aka port-a-cath, infusaport
- surgically implanted line below the skin - tunneled
- external, tunneled through jugular, subclavian, or cephalic/basilic vein
- expensive
- long term months to years
- silicone septum, surrounded by titanium, stainless steel, or plastic
- single or dual ports
- chemotherapy
- Huber needle to access
- less restrictive
(chemo patients)
once a CVAD is inserted, now what?
- when does a nurse assess: dressing change, med admin, IV fluids, prn
- what is the nurse evaluating:
– site: red, leaking, angry, sutures intact
– date: within date, not past 7 days w/o change - when do you notify the PCP/PICC team: s/s infection, no sutures, displacement
complications of CVAD - infection (CLABSI)
- s/s:
– redness, drainage, swelling, discomfort at insertion site
– fever, chills, tachycardia, high WBC count - nursing interventions:
– aseptic technique
– thorough hand hygiene and gloves
– clean injection ports with alcohol swab before every access
– assessments and documentation
– dressing change as indicated
– pt/family teaching
(never touch the dressing with bare hands, put on exam gloves to do an assessment for someone with a central line,
assessment: does anything hurt, is anything bothering you, while palpating area around site
could look angry for first 24-48 hrs, but if it continues to look ugly or gets uglier, could be infection)
complications of CVAD - pneumothorax
air in the pleural space outside the lung
- s/s:
– dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, decreased breath sounds
- nursing interventions:
– monitor vital signs
– administer oxygen
– notify physician, CN, RRT
– prepare for chest tube, if indicated
(aka collapsed lung,
O2 sat would tank, BP and HR would skyrocket,
give oxygen and sit patient up,
notify everyone)
complications of CVAD - air embolism
air entering the circulatory system
- s/s:
– dyspnea, chest pain, tachycardia, hypotension, anxiety, nausea
- nursing interventions:
– keep lumens clamped
– administer oxygen, monitor VS, pulse ox
– place patient on left lateral side in Trendelenburg position
– stay with patient and notify physician, CN, RRT
(patient on left lateral side is to trap air in right atrium)
complications of CVAD
- occlusion: lack of blood return or sluggish flow (in the lumen, bc lumen hasn’t been flushed enough)
- thrombosis: clot that blocks the catheter’s lumen (bc lumen hasn’t been flushed enough)
- catheter rupture: may be caused by excessive force used while flushing (like if flushing a lot with force, doing this could cause dislodging blood clot)
- catheter migration: displacement or lengthening of catheter
catheter occlusion: nursing interventions
if catheter does not have a blood return or will not flush, have patient try the following:
- take deep breaths/cough
- raise arms overhead; reposition arm on same side as the catheter
- have patient sit up/ stand up
- change positions in bed
- place in trendelenburg
- administer Alteplase (not in pixis, special order)
