Vascular Access Devices Flashcards
Peripheral IVs should NOT be used in the following situations:
For continuous vesicant infusion
For solutions with
pH less than 5 or greater than 9
Glucose greater than 10%
Protein greater than 5%
Osmolarity greater than 900 mOsm/L
Midline catheter indications
Limited peripheral veins
Need for access for limited length of time (at least six weeks but possibly months)
Patients with limited life expectancy but needing venous access
Midline catheter contraindications
Patient/caregiver unable to properly care for device at home
Continuous infusion of vesicants
Infusion of solutions with the following
pH less than 5 or greater than 9
Glucose concentration greater than 10%
Protein concentration greater than 5%
Osmolarity greater than 900 mOsm/L
Complications of non-tunneled central venous catheters can include the following:
Insertion complications: pneumothorax, malposition, bleeding, migration of line
Removal complications: air embolus, dyspnea, pain, bleeding, arrhythmias
Other complications: infection, thrombus, catheter fracture, device dysfunction
Implications for Nursing: Non-Tunneled Central Venous Catheter
A catheter placed in emergent situations should be replaced as soon as possible.
A non-tunneled central venous catheter is not intended for long-term IV access.
A catheter should be secured with a securement device because it does not have a cuff or other mechanism holding it in place.
Removal of a catheter can result in air embolus, so precautions should be taken during the removal process.
What is a tunneled central venous catheter
Tunneled catheters are tunneled through subcutaneous tissue terminating in the large vessel near the heart, increasing longevity of the catheter.
Contraindications for use of a tunneled central venous catheter
Sepsis
Infection at insertion site
Coagulopathies
Indications for use of a tunneled central venous catheter
Large volume infusions
Long-term IV access
Vesicant administration
Hemodialysis
Implications for Nursing: Tunneled Central Venous Catheter
A tunneled central venous catheter is an option for long-term IV access.
Although the cuff helps keep the line in place, it is not guaranteed. Care should be taken to ensure the catheter is secure.
Nurses should be aware of the catheter type and whether clamping is required when accessing and deaccessing.
Peripherally Inserted Central Catheter
A peripherally inserted central catheter (PICC) is a type of catheter normally inserted in the upper arm and threaded down into the large vessel near the heart. It has a lower risk of certain serious complications (e.g. pulmonary embolism, infection) than other types of CVADs.
PICC contraindications
Patients who may require arteriovenous fistula formation (veins should be preserved)
Inadequate peripheral vessels for insertion
Patients who require crutches (potential for pressure on vessels/catheter)
PICC indications
Need for longer-term IV access
Frequent blood sampling
Anatomical abnormalities in the chest that prohibit other CVADs
Continuous vesicant infusion
Peripherally Inserted Central Catheter Advantages
- Can be inserted by an RN with specialized training at the bedside or an outpatient setting
- Can be used for longer period of time (12 months)
- Allows for frequent blood sampling
- No risk of insertion-related pneumothorax or great vessel perforation
- Multiple designs available (single, double, triple lumen) and power injection option
- Less expensive than other long-term catheters
- Can be repaired
When is it advisable to consider an implanted port?
Long-term IV access
Vesicant administration
Poor peripheral venous access
Patient desire for implanted port to avoid ongoing catheter dressing care or the appearance of catheter outside body
Contraindications for an implanted port
Younger than six months of age
Open chest wound (peripheral port may be an option)
Tumor involvement of chest wall
Radiation to chest and metal portal body (plastic is preferred in these cases)
