CVC's and PN Flashcards
What is central venous therapy?
- Vascular access device inserted (under sterile conditions) into a peripheral or central vein with the tip lying in the Cavo-Atrial Junction
- Achieved using one of the four devices: centrally inserted catheters, peripherally inserted catheters, centrally inserted ports and peripherally inserted devices
What are the major indications for central therapy?
- Inadequate peripheral access (esp. pt’s who are frequent flyers)
- Complex treatment regimes (e.g. chemotherapy)
- Hyperosmolar infusions
- Infusions of irritating or vesicant drugs
What are other indications for central therapy?
- Rapid absorption, and rapid blood and tissue perfusion
- Long-term IV therapy
- Patient preference
What are considerations when placing a central line?
- Patient condition
- Underlying disease processes
- Anatomical structural deviations or pathologies (e.g. throat and neck cancers)
- IVDU (drug users; less likely to have access to peripheral veins)
- Confused
- Potential need for dialysis (permanent catheter?))
What are some risks and complications?
- Advantages far outweigh the disadvantages, but potential for risks/complications must always be considered
- Can be divided into insertion and long-term complications (e.g. what damage is happening to the vessels themselves?)
- Big insertion risk is infection, as it has potential to spread systemically rapidly
What are typical insertion pathways and placements for central lines?
- Usual sites are subclavian vein, internal or external jugulars (e.g. neck placements)
- Femoral access (less frequent)
- Peripheral access: basilic, cephalic and median cubital
What are the different types of short-term CVC’s?
- Percutaenous (non-tunneled, non-cuffed)
- Midline **
What are the different types of long-term CVC’s?
- Tunneled
- Implanted vascular access devices
- PICC lines
What are the dwelling times for CVC’s?
As long as device is required, functional and not a source of infection
What is the difference between single vs multi-lumen catheters?
- Single, double, triple and quadruple lumen catheters are available
- Each lumen must be treated as a separate catheter
- Incompatible meds can be infused simultaneously via separate lumens (technically meet in bloodstream, but because vessel is large and quickly dispersed in blood stream it is not a problem)
- Exit ports are approximately 2 cm apart along the catheter stem
Describe the suggested uses of lumens in a multi-lumen port design:
PROXIMAL: longest externally, 18 gauge; medication administration
MEDIAL: middle port, 18 gauge; TPN, med or fluid administration
DISTAL: shortest externally, 16 gauge; blood administration, high volume fluids, medication, CVP monitoring and blood sampling
What are open-ended CVC’s?
- Catheter is open at the distal end, so clamps are usually present
- Clamping required before entry into system
- Requires saline (used to use low-dose heparin to keep patent, but saline is just as effective)
- Any type of CVC can be open ended
- Some have proximal valves in the proximal end of the catheter, meaning that a clamp is not required
What are closed-ended CVC’s?
- Valve is present at tip or hub of catheter
- Valve stays closed except when aspirating of infusing
- Clamping not required
- May be present on tunneled CVC’s, IVAD’s and PICC’s
What are advantages of short-term catheters?
- All types of therapies can be administered
- Multiple lumens, large diameters of lumens
- Economical
- Preserves peripheral veins
What are disadvantages of short-term catheters?
- Highest risk of infection and post-insertion complications
- Not for home therapy use or long-term use (complications like bleeding-out can turn bad very quickly, so requires immediate care!)
- Can be easily dislodged
Describe long-term catheters:
- Surgically inserted via percutaneous cut-down (AND surgically removed! Cannot come out without surgery!)
- Generally a tunneled or implanted device/port
- Made of soft, medical grade silicone
- Dacron cuff near exit site
- Can be single or multi-lumen
- Can be open ended or closed
- Portion is tunneled through SC tissue from exit site to insertion site
- Dacron cuff (little raised section on tubing) positioned in the SC tissue to minimize risk of infection and promote securement of catheter
What are implanted ports?
- A type of long-term catheter
- Consists of a portal body, septum, reservoir and catheter
- Can be open-ended or valved (closed) ended
- Surgically inserted
- Accessed aseptically using a non-coring needle
- Septum can withstand up to 2000 punctures!
- Can be implanted into a vessel, organ or cavity
What are advantages to implanted ports?
- All types of therapies can be administered
- Can be single or double port
- No activity restrictions when not accessed
- Body image intact
- Monthly flushing when not in use
What are dis-advantages of implanted ports?
- Surgical procedure to insert
- Requires weekly needle access when in use
What are PICC’s?
- Inserted into peripheral vein and threaded into superior vena cave
- Single or double lumen/triple lumen
- Open ended or valved (closed) ended
- May be sutured or steri-stripped in situ
- Extension tubing attached at insertion remains for the life of the catheter, if a repair is needed and tubing is removed, the extension tubing must be changed weekly with the dressing change
- Inserted by specially trained RN
What are the advantages of a PICC?
- All types of therapies can be administered
- Soft, flexible
- Less potential for insertion complications
- Less expensive
What are dis-advantages of a PICC?
- Not appropriate for high volume or rapid infusions, pre-existing skin conditions, trauma or burns
- May not be able to withdraw blood samples
- Increased possibility of activity restrictions
