CVAD Flashcards
Wha tis a CVAD?
Central Venous Access Device: Allows for administration of things directly into the Superior Vena Cava/Heart
Whatre the 3 lumens coming from the one Catheter on the CVAD used for/
Distal: Blood draws/infusions, meds and CVP
Medial: TPN (Thick nutritional substance)
Proximal: IV Fluids, meds
Where do you insert a CVAD and where does it lead?
Insert into a large central vein to lead to the superior vena cava/right atrium
How do you confirm the placement of a CVAD?
X ray
Why are we slightly moving away from the use of a CVAD?
High infection rate
How long are CVADs used for typically?
Moderate-long term use
Indications/Reasons for CVADs?
- Need for multiple intravenous access
- Hemodialysis
- TPN
- Chemo
- Multiple blood transfusion/blood draws
- Long term antibiotics/IV meds
- Central Venous Pressure monitoring
What is different about the numbers for measuring lumens’ sizes?
Smaller numbers mean bigger
What should we tell the patient when working with CVADS?
- Purpose: what will be administered
- Estimated length of time of how long they’ll have the CVAD
- Inform that it is a sterile procedure and what to expect because of it
What is needed for CVAD insertion?
- Doctors orders and Signed Consent of pt
- Pre and post Vitals
- Sterile Mindset
- Pt in trendelburg position
- PICC team
- Xray Confirmation
Why do we put pt’s in the trendelenburg position for CVAD insertion?
It enlarges the veins to make insertion easier and to lower the chance of an air embolism
What are the 3 types of CVADs?
Which one is the most common?
- Non tunneled (Most common)
- Tunneled
- Port a cath
Where does a Non tunneled CVAD go?
-Directly into with the Subclavian, Jugular, Femoral, or Peripheral vein
How long are non tunneled CVADs used for?
~ 6 weeks
How are non tunneled catheters secured?
Sutures outside of the insertion site to the skin
Why do non tunneled CVADS have a higher infection rate?
There’s a direct opening into the skin
Why can nurses discontinue CVADs?
Cause they were not surgically implanted
What does PICC stand for?
Peripherally Inserted Central Catheter
Where are PICC lines inserted?
The two peripheral veins, Basilic or Cephalic, whichever can be assessed
Why can you not do phlebotomy or take BP in arms with a PICC line?
PICC lines are in the way to take BP and PICC lines can be used to draw blood as well
How are Tunneled CVADs implemented?
They’re surgically implaneted beneath the skin
How are tunneled Catheters unique?
there is a Dacron Cuff on the catheter
How is the Dacron Cuff secured?
Placed SubQ and then secured when scar tissue forms around it
Common sites for Tunneled CVADs.
Subclavian Vein, IJ, and Femoral Vein
How long are Tunneled CVADs for?
Chronically/Longterm (Greater than 6 weeks)
Tunneled CVADs have multiple-
Ports
Can Nurse discontinue Tunneled CVADs?
No, they must be surgically removed
How are implanted ports(Port a cath) inserted?
Surgically implanted beneath the skin.
Where are Implanted ports located?
Tunneled through the jugular, subclavian, or cephalic/basilic veins
How long are Implanted Ports used for?
Months to years
How do you access Implanted ports?
Huber needle
Implanted ports are less-
Restrictive, theyre under the skin when healed so there’s no obstruction
5 knowledge and care protocols for CVADS
- Always assess the CVAD site before any intervention
- Always Scrub for at least 15 seconds
- Always program CVAD infusions to a pump
- Flush Lumens using only 10mL syringes
- Change Dressings 24 hours after insertion and then q 7 days and PRN
What do you assess for when looking at CVAD insertions?
- Sutures and dressing and their dates
- Lumens, Clamps, and Caps
- Fluids/Meds
When should you flush Lumens?
- q Shift
- After every Med
- After every blood draw
What is CLABSI?
Central Lab Associated Blood Stream Infection (The most common complication with CVADs)
Signs and Symptoms of CLABSI
- Redness
- Drainage
- Swelling
- Discomfort
- Fever
- Chills
- Tachycardia
- High WBC count
How to prevent CLABSI?
- Strict Asepsis
- Never touch with bare hands
- Clean with alcohol swab before EVERY access
- Assessments and report concerns
- Change dressings as indicated
- Pt/family teaching
Signs and Symptoms of a pneumothorax
- Dyspnea
- Hypoxia
- Tachycardia
- Restlessness
- Cyanosis
- Chest pain
- Lower breath sounds
- Chest deformaties
Interventions for pneumothorax
- Monitor Vital
- Give O2
- Notify physician, CN, RRT
- Give chest tube if indicated
Signs and Symptoms of a Venous air embolism
- Dyspnea
- Chest pain
- Headache
- Confusion
- Hypotension
- Hypoxia
- Tachycardia
Nursing interventions for Venous air embolisms
- Keep Lumens Clamped
- Give O2
- Monitor Vitals
- Place pt on left lateral side in Trendelenburg position
For a pt with a Venous air embolism, why do we place them how we do?
Tries to keep the air embolism trapped
4 other complications of CVADs?
- Occlusion: Lack of blood return or sluggish flow
- Thrombosis: Clot that blocks lumens
- Catheter Rupture: May be caused by excessive force while flushing with wrong syringe
- Catheter Migration: Displacement or lengthening of catheter
