Vascular Access Devices Flashcards
Vascular Access Devices - Types of catheters used for peripheral & central IV therapy
- Short peripheral catheters
- Midline catheters
- Peripherally inserted central catheters (PICC)
- Non tunneled percutaneous central venous catheters (CVC)
- Tunneled catheters
- Implanted ports
- Hemodialysis catheters (will go over in renal failure & dialysis content)
Technology
- Portable vein transilluminators (for superficial veins)
- Ultrasound-guided peripheral IV insertion (for deeper veins)
Common IV sites of the inner arm
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- Catheter that is 3-8 in long, inserted through veins of the antecubital fossa
- Used for therapies lasting from 1-4 wks
> Rx pH 5-9, final osmolarity <500 - Should NOT be used for infusion of vesicant medications, which can cause tissue damage if they escape into the subcutaneous tissue (extravasation)
! Do not use to draw blood; do not use on mastectomy sides, lymphedema, or dialysis grafts
NOT FOR PARENTERAL NUTRITION
> The distal tip ends up in a peripheral vein; is NOT a central device
Midline catheter
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- Length ranges from 18-29 in; cxr to determine placement
! Tip in the SVC - Midclavicular lines have a higher association of thrombosis
- Lines are single, double, or triple lumen
- Insertion complications like pneumothorax don’t really happen; lower infection rate r/t drier skin areas; less expensive
- For ALL types of infusion
- No limit on pH or osmolarity
- Can use months to years
- Can use for blood draws for 4 Fr or greater in size
> Avoid strenuous activity
Peripherally inserted central catheter (PICC)
Catheter-Related Bloodstream Infection (CRBSI) Bundle
- Proper aseptic hand hygiene
- Measuring upper arm circumference as a baseline before insertion
- Maximal barrier precautions on insertion
- Chlorhexidine skin antisepsis
- Optimal catheter site selection & post-placement care w/avoidance of the femoral vein for central venous access in adult pts
- Daily review of line necessity w/prompt removal of unnecessary lines
> CLABSI
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- Inserted through subclavian vein in the upper chest or jugular veins in the neck
- Usually 15-20 cm long (7-10 in)
- Tip resides in the SVC
- Placement confirmed by cxr
- No recommendations for optimal dwell time
- A quick, short-term solution. Not optimal b/c higher infection rates
Non tunneled percutaneous central catheter
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- Portion of catheter lying in a subcutaneous tunnel separates the point @ which the catheter enters the vein from where it exits the skin
- Used for infusion therapy that’s frequent & long-term
> Tesio, Broviac, Hickman, Leonard
* Use this type versus a PICC for paraplegics d/t using rt upper arm a lot
Tunneled central catheter
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- Portion of catheter lying in a subcutaneous tunnel separates the point @ which the catheter enters the vein from where it exits the skin
- Used for infusion therapy that’s frequent & long-term
> Tesio, Broviac, Hickman, Leonard
* Use this type versus a PICC for paraplegic’s d/t using upper arm a lot
Tunneled central catheter
Implanted Ports
- Implanted ports consist of a portal body, a dense septum over a reservoir, & a catheter
- A subq pocket is surgically created to house the port body
- Port is usually placed in the upper chest or the upper extremity
- Ports needs to be flushed after each use & at least once/month between courses of therapy
- Order for a topical anesthetic cream as can have pain upon being accessed; can be accessed up to 2000x
Local complications of IV therapy
- Infiltration
- Extravasation
- Phlebitis & post-infusion phlebitis
- Thrombosis
- Thrombophlebitis
- Ecchymosis & hematoma
- Site infection
- Venous spasm
- Nerve damage
Systemic Complications of IV Therapy
- Circulatory overload
- Speed shock
- Allergic reaction
- Catheter embolism
Insertion-Related Complications of CVC’s
- Pneumothorax
- Hemothorax
- Chylothorax
- Hydrothorax
- Air embolism
Nursing Care for Pts Receiving IV Therapy
- Educate patient
- Performing the nursing assessment
- Securing & dressing the catheter
- Changing administration sets & needleless catheters
- Controlling infusion pressure
- Flushing the catheter
- Obtaining blood samples from CVC’s
- Removing the vascular access device
- Documenting IV therapy
Consideration for Older Adult Care
- Skin care (loses subq fat; fewer nerve endings alters pain perception & other sensations)
- Vein & catheter selection
- Cardiac & renal changes
> Older adults can be more prone to fluid overload, which can result in HF or dehydration w/subsequent poor profusion
- A dressing change can tear off layers of (brittle) skin (be careful)
