Parenteral Access Devices Flashcards
Name 2 large central veins?
Inferior vena cava (IVC)
Superior vena cava (SVC)
Which is the main vessel for venous return from the upper trunk emptying into the right atrium?
Superior vena cava (SVC)
What is the preferred vessel for PN solutions via central access and its estimated blood flow per minute?
SVC
2000 ml/min
What does diameter refer to with catheter measurements?
Can refer to the internal or external diameter and is measured in millimeters. Depending on the catheter material, the internal diameter may vary between catheters with the same external diameter
What is French size?
A measure of the outer diameter (1 mm = 3 Fr.)
What is gauge measurement of catheters?
A unit of measure that is inversely proportional to the catheter’s outer diameter
What is a benefit of a multilumen CVC?
Provides for simultaneous infusion of multiple solutions or incompatible drugs
What is a CVC cuff?
Designed to serve as a subcutaneous anchor and mechanical barrier
What is a Dacron cuff?
Most often attached to tunneled catheters. Positioned in the subcutaneous tissue and serve to anchor the catheter by facilitating fibrous ingrowth
What is a collagen cuff?
Impregnated with silver ions, the gradual release of the silver ions exerts short-term antimicrobial activity
What is a Groshong catheter?
A venous access device with a pressure sensitive 3-way slit valve on the tunneled catheter which eliminates the need for daily heparinized flushes and catheter clamping before disconnecting at the catheter hub
What substance are catheters most often made of?
Polyurethane or silicone
What is a negative effect of using PVC catheters?
Have been associated with an increase in thrombus formation and phlebitis compared with other polymeric catheters
Describe some characteristics of polyurethane catheters?
Smooth surface which demonstrates resistance to hydrolytic enzymes. Greater tensile strength than silicone and lower degrees of microbial colonization
Describe characteristics of silicone catheters?
Excellent elasticity and softness, cause less damage to the vessel intima. Low inflammatory-provoking potential in the tissues, surface is less attractive for adherence of microbial populations when compared with other biomaterials. Tends to be chemically inert to blood with reduced plasma adherence
What is a common complication of silicone catheters?
Fibrin sleeve formation
Where are peripheral catheters inserted and where do they terminate?
Enter and terminate in peripheral veins in the hand and lower arm
Where is the tip located in central catheters?
Distal CVC, IVC, or right atrium
List advantages of peripheral catheters
Least expensive
Least risk for catheter-related infections
Does not require a special placement room
Clinicians easily trained in placement
What type of PN is not appropriate for peripheral use?
PN that has a final concentration >10% dextrose or other additives that result in an osmolarity >900 mOsm/L
What is the leading complication associated with peripheral access?
Peripheral venous thrombophlebitis
What are the hallmark signs of infusion phlebitis?
Pain, erythema, tenderness, palpable cord
Where does the catheter tip reside in midline catheters?
Basilic or cephalic vein, with the tip at or before the axilla, distal to the shoulder
What is an advantage of a midline catheter?
Lower phlebitis rates than standard, short peripheral catheters and lower rates of infection than CVADs
What type of IV therapy is a midline peripheral catheter appropriate for?
Peripheral compatible solutions where treatment is considered for 2-6 weeks
What are the most common sites of venipuncture for central access?
Cephalic, basilic, subclavian, jugular, and femoral veins
Which vein is preferred for SVC access for patients with CKD who might require dialysis?
Right internal jugular vein
What are the 3 categories of CVADs?
Nontunneled
Tunneled
Implanted
Which catheter is ideal for all situations?
None, catheter choice is guided by the advantages and disadvantages with various optoins
A venous site where the catheter-to-vein ratio is equal to or less than what % should be selected to minimize the risk of venous thrombosis when placing a PICC?
45%
Where can PICC line placement occur?
At patient’s home, at the bedside, or IR
List some advantages of a PICC line?
Safer insertion in the arm
Cost-effectiveness
Convenience of placement by vascular access teams
What complications may PICC lines lead to?
Luminal occlusions
Malpositioning and dislodgement
Infection at PICC insertion site
Superficial thrombophlebitis at insertion site
True or false: PICCs are not appropriate for infusion of irritants and vesicants such as PN and chemo for any length of duration
False. They are appropriate
What is the theory behind catheter tunneling decreasing the risk of catheter infection?
It separates the exit and venipuncture sites
What is the length of time that tunneled catheters have been demonstrated to be safe and effective for?
Long-term therapies ranging from months to years
Name some advantages to tunneled CVCs
Ease of self care by the patient
Placement on the chest wall so they are covered by clothing
Decreased risk of dislodgement
Ability to repair the external lumen in the event of catheter breakage
What sites can be used when repeated catheterizations to common vein sites affect the likelihood of the vein’s preservation?
Translumbar, transhepatic, and transcollateral