Peripheral and Central IV Access Flashcards
What veins are used for Central Venous Access Devices (CVADs)?
Internal jugular Subclavian Vein Brachial Vein Femoral Vein Can also be implanted under the skin.
Where does the tip of a CVAD terminate?
In the superior or inferior vena cava.
What dose CVAD stand for?
Central Venous Access Device
How is CVAD placement confirmed?
X-ray or placed under fluoroscopy
Indications for CVAD
Parenteral nutrition
Chemotherapy and other vesicant or irritating solutions
Blood products
Antibiotics
Limited peripheral access for medications/IV fluids
Central venous pressure monitoring
Hemodialysis
CVAD: Lumen(s)
A lumen is a tube within a catheter.
CVAD: Single Lumen
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.
CVAD: Single Lumen
Limitations
Cannot draw blood after infusion or be used to infuse blood.
CVAD: Multi-Lumen
Multiple tubes within the catheter that terminate independently and allows for multiple infusions/blood sampling without mixing. These can have 2-5 lumens.
CVAD: Ports
Each port is associated to a lumen. Refer to the manufactures labeling to differentiate the ports.
CVAD: Proximal Lumen
Opens closest to the entry site and furthest from the R atrium. Use for administering blood or medications.
CVAD: Medial Lumen
Opens between the proximal and distal lumens. Used for parenteral nutrition.
CVAD: Distal Lumen
Opens furthest from the entry site and closest to the R atrium. Used for administration of blood or other viscous solutions.
Four types of CVAD
Tunneled CVAD
Non-tunneled CVAD
Peripherally Inserted Central Catheter (PICC)
Implanted Venous Port
Non-Tunneled CVADs are used for _______ Therapy.
Short Term
Indications for Non-Tunneled CVAD
Blood Sampling
IV Therapy
Central Venous Pressure Monitoring
Non-Tunneled CVAD: Insertion and Termination
Insertion: Percutaneous venipuncture in the subclavian or internal veins.
Termination: Catheter terminates in the superior vena cava.
Non-Tunneled CVAD: Nursing Considerations
Due to the risk risk of infection non-tunneled CVADs should be evaluated daily for need and potential for removal.
Non-Tunneled CVAD: Benefits and Risks
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.
Tunneled CVADs are used for _____ Therapy
Long Term
Tunneled CVADs are considered permanent.
Tunneled CVAD: Insertion and Termination
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.
Uses for Tunneled CVAD
Hemodialysis Chemotherapy Administering fluids Parenteral nutrition Blood sampling Central venous pressure monitoring
Non-Tunneled CVAD: Benefits and Risks
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
Non-Tunneled CVAD: Nursing Considerations
It takes about 3 weeks for the tissue to heal around the catheter.
