CVAD Essentials Quiz

Questions and Answers

What is the primary indication for the administration of fluids through a CVAD?

Extracorporeal therapies

Frequent access to the bloodstream (correct)

Hemodynamic monitoring

Venous blood sampling

What is the purpose of a CVAD in hemodynamic monitoring?

To provide total parenteral nutrition

To monitor central venous pressure (CVP) and cardiac parameters (correct)

To administer IV fluids or medication

To facilitate extracorporeal therapies

What is the duration of a non-tunnelled percutaneous CVAD?

Permanently implanted

Several months to a year

Days to several weeks (correct)

A year or more

What is the benefit of using a power injectable catheter?

Increased flow rates Signup and view all the answers

What is the purpose of the distal port in a triple lumen catheter?

Monitor Central Venous Pressure (CVP) Signup and view all the answers

Why is proper aseptic technique crucial when handling a CVAD?

To reduce the risk of infection Signup and view all the answers

What is the primary advantage of using a PICC over a non-tunnelled percutaneous CVAD?

Longer duration of use Signup and view all the answers

Why is it essential to clamp the luer lock connections firmly?

To prevent air embolism and haemorrhage Signup and view all the answers

What is the primary purpose of a CVAD in extracorporeal therapies?

To provide access for haemodialysis or plasmapheresis Signup and view all the answers

What is the recommended duration for changing luer lock connections?

Every 3 days or according to hospital protocol Signup and view all the answers

Why is regular maintenance of a CVAD essential?

To prevent infection and maintain patency Signup and view all the answers

What is the purpose of flushing the central venous line with heparinised saline?

To prevent clotting and maintain patency Signup and view all the answers

What is the primary purpose of using standard precautions when handling CVCs?

To prevent infection Signup and view all the answers

How often should you swab each port with alcohol swabs before use?

At least 10 times or 10 seconds Signup and view all the answers

Who is authorized to flush the central venous line?

Trained staff only Signup and view all the answers

What should you do when the luer-lock cap is removed from the catheter?

Replace it with a new one Signup and view all the answers

What is the primary purpose of using a Trendelenburg position during central venous catheter insertion?

To prevent air embolism Signup and view all the answers

What solution is used for flushing the central venous catheter?

Heparin saline Signup and view all the answers

What is the purpose of using a levelling device during CVP monitoring?

To level the CVP manometer Signup and view all the answers

Why is it essential to check the patient's coagulation profile before inserting a central venous catheter?

To determine the patient's bleeding risk Signup and view all the answers

What is the purpose of using a transparent dressing during central venous catheter insertion?

To monitor the catheter insertion site Signup and view all the answers

What is the primary purpose of using Chlorhexidine 2% in 70% alcohol for cleansing during central venous catheter insertion?

To disinfect the skin Signup and view all the answers

Why is it essential to perform hand hygiene and don PPE before inserting a central venous catheter?

To prevent infection transmission Signup and view all the answers

What is the primary purpose of using ultrasound during central venous catheter insertion?

To visualize the blood vessels Signup and view all the answers

Study Notes

Central Venous Access Devices (CVAD)

Definition: Small, flexible tubes placed in large veins for people who require frequent access to the bloodstream, can also be implanted under the skin.

Indications

Administration of fluids, total parenteral nutrition, IV fluids or medication, blood or blood products transfusions, and IV therapy in a long-term ambulatory setting or home.
Hemodynamic monitoring - central venous pressure (CVP), cardiac parameters.
Extracorporeal therapies - Haemodialysis / plasmapheresis.
Venous blood sampling.
Introducer sheath – Transvenous cardiac pacing, Inferior vena cava filter placement, venous thrombolytic therapy, venous stenting.
Difficult peripheral venous cannulation.

Types of Central Venous Devices (CVAD) and Insertion Sites

Short-Term devices: • Non-tunnelled percutaneous (non-cuff): single, double, triple, quadruple or quintuple lumen, comes in variety of lengths 15-30cm, inserted in subclavian, internal jugular and femoral veins. • Peripherally inserted central catheters (PICCs): Power injectable catheters; single, double or triple lumen, inserted in basilic / cephalic vein.

Principles of Care of CVC

Strict aseptic technique: clean each port with alcohol swabs before use, at least 10 times or 10 seconds.
Standard precautions.
Maintain closed system: use luer lock connections, change every 3 days or following hospital protocol, clamp firmly near to the exit port.
Maintain catheter patency: • Avoid interrupted flow during infusion. • Ensure adequate and correct flushing technique of central venous access device (by TRAINED STAFF ONLY). • Flush with 10 mls of normal saline after blood withdrawal, and with 5mls of heparinised saline when not in use (confirm with hospital protocol).

Insertion Procedure

Obtain informed consent.
Check patient’s coagulation profile - PT/PTT.
Explain procedure to patient to allay fear and anxiety and gain cooperation.
Prepare site for insertion: landmarking (done by Dr), shave hair at site of insertion (if necessary).
Position: Trendelenburg (if haemodynamically stable) or supine (if unstable).
Check allergy status: Lignocaine? Chlorhexidine sensitive?
Equipment / Requisites: • Central venous catheter kit (Bundle). • Sterile gloves/surgical gown/cap/drape/mask/syringes/needles/ultrasound sleeves. • Lignocaine 1%. • N/S and Heparin saline for flushing. • Cleansing solutions per protocol - Chlorhexidine 2% in 70% alcohol or chloroprep stick swab. • CVP manometer – if CVP monitoring is required. • Levelling device (e.g., carpenter ruler) if CVP monitoring is required. • Transparent dressing. • Bed-side ultrasound machine. • Time out checklist.

Implementation

Hand hygiene and don PPE.
Carry out time-out.
Prepare site for insertion – expose the area, remove patient’s top, necklace/chain.
Place protective sheet underneath the selected site.
For jugular / subclavian placement, place patient in Trendelenburg’s or supine position to prevent air embolism.

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Test your knowledge on Central Venous Access Devices (CVAD) definition, uses, and importance in healthcare. Take this quiz to assess your understanding of CVAD