CVC Flashcards
Uses of CVCs
TPN (peripheral veins can’t handle high dextrose and glucose levels), chemo, long-term abx, loss of peripheral access
“Deep line”
Non-tunneled CVC
Non-tunneled CVCs
- tip lies in the superior VC
- inserted by the HCP or specialized RN
- short-term—not for home
Where does a deep line enter?
Subclavian or internal jugular
Risks of nontunneled CVCs
Nicking the pleura (pneumothorax), bleeding, air embolism
What kind of non-tunneled CVC is best for noncompatible drugs
3 lumen
Type of tunneled CVCs
Hickman, Groshong, Broviac
Why do most patients have tunneled CVCs?
For chemo
Implanted ports
- aka portacath or PowerPorts
- implantable venous access
- no external tubing
Peripherally inserted central catheter (PICC)
Tip lies in superior vena cava, end comes out on arm
CLABSI
Central line associated bloodstream infection
- bacteria in the line
Non-tunneled CVC removal
- check INR if on anticoagulant
- need sterile suture removal kit, sterile and clean gloves, occlusive dressing, measuring tape
- explain procedure
- lay supine or trendelenburg
- Valsalva maneuver—ask pt to hum
- pressure for 3-5 minutes, occlusive dressing
IV Cath dressing
Statlock—stabilization device—Dec wiggling, hole size, infection
Tunneled CVC
- does not go thru the vein from skin—tunnels thru tissue to get to skin internally
- placed in OR
- used when infusion therapy is frequent and prolonged (even years)
- irrigation protocol varies—may need heparin
- site dressing per policy
- removed by HCP
Advantages and disadvantages of tunneled CVC
Adv—no needle sticks
Disadv—break in skin integrity
Complications of tunneled CVCs
Catheter damage, occlusion, thrombosis, sepsis
Implanted port
- under SQ tissue
- for pt who need semi-permanent IV access up to 1 year
- placed in OR, Cath attached to port, placed in pocket of SQ tissue on chest wall
- irrigation protocol varies
- no site care
- HCP removes
- complication—occlusion
What type of needle is used for implanted port and how long can it be used?
Huber needle
- can get up to 2000 punctures with Huber in chest
- can get 750 punctures in upper arm
- change needle weakly
Complication of implanted port
Occlusion
Advantage of implanted ports
Least impact on body image
PICC line
- nontunneled
- tip lies in superior vena cava
- peripherally inserted
- inserted at bedside in bend of elbow (antecubital fossa or cephalic vein)
- no BP/sticks in arm
- lasts 3-12M
post-procedure for deep tunnel
Chest X-ray
Complications of PICC line
Phlebitis, catheter occlusion
Benefit of PICC line
Fewer complications that CVC—fewer microorganisms on arm and easier to insert
PICC line removal procedure
RN removes
- bear down, hold arm below heart, w/d inch by inch and pause to avoid vasospasm; don’t pull if vein spasms
- measure length at the end
Only thing UK students can do with a CVC
Hang secondary is a primary is already running
