CVAD Flashcards
CVAD =
central venous access devices
what is a CVAD?
intravenous catheter or infusion port designed to administer medications, nutrients, IV fluids, and blood products
where is the CVAD placed?
central vein to the heart
one catheter has multiple __, ___, ___
lumens, gauges, and exits
_____ diameter for thicker fluids to go through lumens
larger
distal lumen is for
blood draw, blood infusions, medications, CVP
proximal lumen is for
IV fluids, medications, blood draw
medial lumen is for
TPN (total parental nutrition)
indications for CVAD
peripheral access not available or contraindicated, for moderate long-term use, need for multiple IV access, hemodialysis, TPN, chemotherapy, multiple blood transfusion, longterm abx/IV meds, and central venous pressure monitoring
___ the lumen/gauge the wider the diameter of needle
smaller
CVAD insertion: pre and post protocols
Dr’s order & signed consent, pre/post vital signs/assessments, initiate sterile mindset, pt in trendelenburg position, standby assist for physician/PICC team, X-ray confirmation
why do you place a patient in trendelenburg position for CVAD insertion?
enlarges vein and helps decrease chance for air embolism
types of CVAD
non-tunneled, tunneled, and Port-A-Cath
non-tunneled CVAD is most common and inserted directly into
subclavian, jugular, femoral, or peripheral vein
non-tunneled are secured by what and where?
sutures outside the insertion site to the skin
non-tunneled CVAD are used for how long?
acute, moderate to long term (approx. 6 weeks)
non-tunneled have a ____ rate of infection than tunneled
higher (because hanging outside skin, opened air into skin)
nurse can discontinue a non-tunneled because ___
it is not surgically implanted
PICC means
peripheral inserted central catheter
PICC- which two veins are used if what can be accessed?
cephalic or basilic vein; if the peripheral vein
if there is a PICC, what would you not perform?
no phlebotomy or blood pressures in arm
tunneled CVAD: broviac, groshong, hickman are done ____ & where?
surgically; beneath skin
tunneled CVAD are unique due to ____ cuff on the catheter and the cuff is ___ in place in _____ initially then scar tissue secures itself around the cuff
Dacron; surgically placed in SQ tissue
Dacron cuff helps secure and ___ ____
prevent infection
common sites for tunneled CVAD:
subclavian vein, IJ (internal jugular vein), can also be placed in a femoral vein
tunneled CVAD can have ____
multiple ports
nurses cannot do what with tunneled CVAD?
discontinue because they need to be surgically removed because the dacron cuff needs to be cut out
implanted port: port-a-cath, infusaport
surgically implanted line underneath
implanted port: port-a-cath, infusaport are tunneled through
jugular, subclavian, or cephalic/basilic vein
implanted port are long term: ____ to ____
month to years
implanted port: port-a-cath, infusaport are used for ____ through a ____ or ____
chemotherapy; single or dual port
____ needle to access an implanted port
huber
CVAD knowledge & care (5)
- always assess the CVAD site before any interventions - sites/sutures/dressing/date, lumens/clamps, and fluids/meds
- always “scrub the hub” (max-zero cap) at least 15 seconds before accessing
- Always program CVAD infusions to a pump
- flush lumen(s) using only 10 mL flush syringes
- dressing changes
when do you flush lumens?
every shift, after every medication, and after every blood draw
when do you change dressings for CVAD?
24 hours post-insertion and every 7 days & PRN, the max-zero caps every 7 days with dressing change & PRN
Complications of CVAD: CLABSI
central line associated blood stream infection - most common complication
signs and symptoms of CLABSI
redness, drainage, swelling, discomfort at insertion site, fever, chills, tachycardia, and increased WBC
nursing interventions to prevent clabsi
strict asepsis, never touch with bare hands, clean injection ports with alcohol swab before every access, assessment, dressing changes as indicated, pt/family teaching
complications of CVAD: pneumothorax
air in the pleural space outside the lung (collapsed lung)
signs and symptoms of pneuomothorax
dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, decreased breath sounds, obvious “chest deformity”
nursing interventions for pneumothorax
monitor vital signs, administer oxygen, notify physician, CN, RRT, and prepare chest tube if indicated
complications of CVAD: venous air embolism
air entering the circulatory system
signs and symptoms of venous air embolism
acute dyspnea, chest pain, headache, confusion, hypotension, hypoxia, and tachycardia
nursing interventions for venous air embolism:
keep lumens clamped, administer oxygen, monitor VS, pulse ox, place patient on left lateral side in trendelenburg position
why do you place patient in trendelenburg position for a nursing intervention for venous air embolism?
trap air embolism in right atrium so it doesn’t leave and go to the rest of the heart or brain
complications of CVAD: occlusion
lack of blood return or sluggish flow
complications of CVAD: thrombosis
clot that blocks the catheter’s lumen
complications of CVAD: catheter rupture
may be caused by excessive force used while flushing and wrong flush syringe
complications of CVAD: catheter migration
displacement or lengthening of catheter
catheter occlusion nursing interventions:
if no blood return or will not flush, have patient take deep breaths/cough, raise arms overhead/position arm on same side as the catheter, have pt sit up/stand up, change positions in bed, place in trendelenburg, administer alteplase
alteplase is used for?
dissolve blood clots that have formed in the blood vessels
CVAD catheter removal:
Dr’s orders, CVAD kit, suture removal kit, petroleum based gauze
hold pressure 5 minutes or until bleeding stops
position for CVAD catheter removal:
supine position, hold breath, and pull line with deliberation
how long do you hold pressure after CVAD catheter removal and remain in ____ position for at least ____ minutes post-removal
supine; 30 minutes
CVAD catheter removal PICC line:
same as catheter removal, cover with occlusive dressing and leave on for 48 hours, must add 4x4 folded gauze over occlusive dressing & secure with Coban wrap, measure catheter length of PICC line and record, 30 min supine position
how long do you leave on occlusion dressing after removal for CVAD?
24 hours
CVAD dressing change steps:
gather supples (extra sterile gloves), introduce self and procedure, hand hygiene, identify pt, allergies/readiness, raise bed level of comfort, place patient in supine position with HOB 30 degrees if tolerated, position overbed table, hand hygiene, assess site/lumes/clamps, apply gloves/clean over-bed table, remove gloves, HH, open CVAD kit, then follow kit steps
how long do you scrub the insertion site and what motion? what order?
30 seconds, back and forth, insertion site, hub, lumens
