CVC Flashcards
when is a CVC indicated?
> admin solutions that are irritating to periph veins
venous access to periph veins not good
rapid admin of large amounts of fluid and rapid perfusion
needed for long term (hemodialysis)
uninterrupted admin of several solutions at same time
drawing of blood samples
to monitor CVP
hyperosmolar infusions
What is a CVC
A vascular access device that is inserted under the skin, into peripheral or central vein. Tip lies at Cav0-Atrial Junction (inferior end of superior vena cava)
for femoral CVC- ends in inferior venacava at diaphragm level
what a the 4 access sites for CVC?
- centrally inserted cath
- peripherally inserted cath
- centrally inserted port
- peripherally inserted port
what to consider for PT CVC
risks and complications
- are they IDU?
- confused
- potential need for dialysis
RandC: 1. cardiac dysrhythmias 2. pneumothorax- air in plural cav usually d/t insertion technique. > dyspnea, cyanosis, pain bhnd clavical, hypotension, tachycardia, asymmetric chest movement, decreased breath sounds 3. bleeding 4. hematoma 5. hemothorax 6. catheter malposition 7. venous thrombosis 8. infection 9. occlusion - flush bfr and after use 10. migration/dislodgement 11. air embolis - position PT in left sided trandelenburg, clamp CVC, CPR, call doc signs: > CNS changes: altered neuro, dizzy, LOC > CVS: sudden onset chest pain, increased HR, decreased BP, >resps: SOB cyanosis
insertion pathways and placement
- Subclavian, internal/external jugular
- less frequent is femoral
- periph- basilis, cephalic and median cubital
Central inserted catheters can be?…
- single or multi lumen
- open or closed
- valved or not
- short term/long term
short term cath: central
vs
long term:
S: percutaneous
non-tunneled, non cuffed
L: tunneled, IVAD (implanted vascular access device), PICC (peripheral, inserted central catheter)
can dwell for as long as needed
export ports of multi lumen are how far apart?
proximal
medial
distal
2 cm
prox: longest, 18 gauge, medication admin
medial: 18, TPN/med/fluid admin
distal: short externally, 16, blood/high vol fluids/meds/CVP/blood sample
open ended
vs
closed ended
Open:
>cath open at distal end
> rqrs clamp bfr entering system
>rqrs SALINE flush
Closed:
> valve present at tip or hub of cath
> stays closed except when aspirating or infusing
> clamp not rqrd, bc valve is at distal end
> may be present on tunneled CVC, IVAD and PICC
aspirate = neg pressure infuse = poss pressure
short term
vs
long term
short: Advantages: > all type therapy can be admin > mult lumens, larger diameter > economical >preserves periph veins
> PICC- 6 days to one year
Disadvantages:
> highest risk for infection and post insert complications
> not for home therapy use or long term
> can be easily dislodged
long term:
>generally tunneled or implanted device/port
> made soft medical grade silicone
> Dacron cuff near exit site = SC tissue granulates onto and becomes a barrier to prevent organisms
also anchor
>surgically insert- percutaneous venipuncture
> can be open or closed
> can be single lumen or mult
> can last months to years (hemodialysis)
long term cath implanted ports
Advantages: > all type therapies > can be single/double > no activity restrictions > body image intact > monthly flushing when not used
Disadvan:
>surgical
> requires weekly needle access
long term PICC
> periph vein to superior vena cava > single/double/triple > open/closed > maybe sutured or steristrip into place > can sometimes be inserted by RN
Advan:
> all therapies, not expensive, less potential insertion complications
Disadvan: > not aprop for high vol or rapid infusion, preexisting skin conditions, trauma/burns > may not for withdraw blood > some activity restrictions > frqnt dressing changes
what is a power CVC?
the purple means that you can see it on an xray bc it allows injection of contrast
daily assessment:
> dressing D and I
site: inflam, drainage, edema, bleeding, bruising
palp site: infiltration and SC emphysema
check system- measurement
dressing changes steps:
> change 6-7 days (FH sundays)
cleans work area
apply the impreg Chlorhex if infected of for the first time
