Week 8 - CVADs Flashcards
What are the diff. types of CVADs?
- non tunnelled - R. jugular/subclavian vein
- IVAD/Portacath - chemo drugs
- PICC - tip in Central venous system
- Tunnelled - long term access - tunnels under the skin
When are CVADs indicated?
- Long term IV access - 3+ weeks to years
- Parenteral nutrition - vesicant
- chemo/vesicant/irritating solutions
- blood products
- Antibiotics - longer therapy
- IV meds/solutions when IV access is limited
- central venous pressure monitoring
Where does the blue line end up on the tip?
Proximal
Where does the yellow line end up on the tip?
Distal
Where does the red line end up on the tip?
Medial
What do open-ended tips require to be flushed with?
Saline flush & heparin
Broviac and Hickman - tunneled
What do valved tips require to be flushed with?
NS
Groshong - PICCs
With open ended tips, what are we worried about?
- clotting d/t back flow
- air getting in
What are the advantages of the PICC?
- easy to insert at bedside - don’t need general anasthetic
- Nurses can do it with certification
- long term antibiotics (6-8 wks)
- TPN, chemo
- Long term
- Single and double lumen
- Valved - no heparin needed
What are the disadvantages to PICCs?
- no vigerous movement
- no swimming - maybe bathing/showering allowed
How many lumens are tunneled CVAD?
1-3 lumens
How long do non-tunneled CVADs stay in?
Up to 1 week in hospital
How many lumens does a non-tunelled have?
1-4 lumens
What are the risks of non-tunneled CVAD?
- risk for infection is greater
- venipuncture above the lungs = risk for pneumothorax
What type of needle is used to access the IVAD?
Huber (non-barbed, non-coring)
Where are IVADs found on the body?
- Chest
- Abdomen
- Arm
- Leg
What do we use if accessing an IVAD/port-a-cath is painful?
Emla cream
What is a VAS CATH used for?
hemodialysis
- in an emergency they can be accessed for something other than dialysis
What are the complications with CVADS?
- Hemorrhage
- Hemothorax/pneumothorax
- Surgical emphysema
- Local cellulitis
- Local hematoma
- Air embolus - medical emergency
- Dysrhythmias - irritate the heart
- Malposition - wrong location (verify with xray/ultrasound)
What are the complications of CVAD use?
- Phlebitis (angry vein) - less common than IV
- Infiltration/extravasation - measure length
- Infection
- Air embolism
- Thrombosis
What do we do if a CVAD line is pulled out?
- cover site with air-occlusive dressing
- Patient on left side
- Trendelenburg position
- stay with patient and get colleague to contact doctor
What are the signs of air embolism relating to CVAD complication?
- Dyspnea
- Chest pain
- Tachycardia
- Hypotension
- Anxiety
- Nausea
- Dizziness
- Confusion
Why do we put patients in trendelenburg position with air embolism?
To trap the air in the bottom of the right ventricle (so it doesn’t go to the lungs)
What is the typical amount of saline and heparin used when accessing a subclavian (non-valved) CVAD?
10-20 NS flush
200 units heparin lock
