Peripheral and Central IV Access

Question 1

What veins are used for Central Venous Access Devices (CVADs)?

Answer 1

Internal jugular
Subclavian Vein
Brachial Vein
Femoral Vein
Can also be implanted under the skin.

Question 2

Where does the tip of a CVAD terminate?

Answer 2

In the superior or inferior vena cava.

Question 3

What dose CVAD stand for?

Answer 3

Central Venous Access Device

Question 4

How is CVAD placement confirmed?

Answer 4

X-ray or placed under fluoroscopy

Question 5

Indications for CVAD

Answer 5

Parenteral nutrition
Chemotherapy and other vesicant or irritating solutions
Blood products
Antibiotics
Limited peripheral access for medications/IV fluids
Central venous pressure monitoring
Hemodialysis

Question 6

CVAD: Lumen(s)

Answer 6

A lumen is a tube within a catheter.

Question 7

CVAD: Single Lumen

Answer 7

The catheter is a single tube terminating in a hub. These can be connected to tubing for continuous infusion or capped for bolus infusions/medication administration.

Question 8

CVAD: Single Lumen

Limitations

Answer 8

Cannot draw blood after infusion or be used to infuse blood.

Question 9

CVAD: Multi-Lumen

Answer 9

Multiple tubes within the catheter that terminate independently and allows for multiple infusions/blood sampling without mixing. These can have 2-5 lumens.

Question 10

CVAD: Ports

Answer 10

Each port is associated to a lumen. Refer to the manufactures labeling to differentiate the ports.

Question 11

CVAD: Proximal Lumen

Answer 11

Opens closest to the entry site and furthest from the R atrium. Use for administering blood or medications.

Question 12

CVAD: Medial Lumen

Answer 12

Opens between the proximal and distal lumens. Used for parenteral nutrition.

Question 13

CVAD: Distal Lumen

Answer 13

Opens furthest from the entry site and closest to the R atrium. Used for administration of blood or other viscous solutions.

Question 14

Four types of CVAD

Answer 14

Tunneled CVAD
Non-tunneled CVAD
Peripherally Inserted Central Catheter (PICC)
Implanted Venous Port

Question 15

Non-Tunneled CVADs are used for _______ Therapy.

Answer 15

Short Term

Question 16

Indications for Non-Tunneled CVAD

Answer 16

Blood Sampling
IV Therapy
Central Venous Pressure Monitoring

Question 17

Non-Tunneled CVAD: Insertion and Termination

Answer 17

Insertion: Percutaneous venipuncture in the subclavian or internal veins.

Termination: Catheter terminates in the superior vena cava.

Question 18

Non-Tunneled CVAD: Nursing Considerations

Answer 18

Due to the risk risk of infection non-tunneled CVADs should be evaluated daily for need and potential for removal.

Question 19

Non-Tunneled CVAD: Benefits and Risks

Answer 19

Benefits: Insertion does not require sedation, can be performed at the bedside or in emergent situations

Risks: Higher risk of infection, increased risk of pneumothorax.

Question 20

Tunneled CVADs are used for _____ Therapy

Answer 20

Long Term

Tunneled CVADs are considered permanent.

Question 21

Tunneled CVAD: Insertion and Termination

Answer 21

Insertion: Tunneled CVADs are inserted through the skin in the chest and tunneled under the skin before being threaded into a large vein.

Termination: Catheter terminates in the superior vena cava.

Question 22

Uses for Tunneled CVAD

Answer 22

Hemodialysis
Chemotherapy
Administering fluids
Parenteral nutrition
Blood sampling
Central venous pressure monitoring

Question 23

Non-Tunneled CVAD: Benefits and Risks

Answer 23

Benefits: Lower risk of infection for long term use, exit site is convenient for care and can be hidden under clothing.

Risks: Requires implantation under sedation

Question 24

Non-Tunneled CVAD: Nursing Considerations

Answer 24

It takes about 3 weeks for the tissue to heal around the catheter.