Vascular Access Procedures Complications PDF

# Complications of Vascular Access procedures ## Prevention **Prevention, cont.** * For high-risk patients, consider the experience of the clinician and consult an expert clinician for insertion. * Maintain vigilant awareness of needle depth and advancement if tip of needle cannot be tracked cont...

# Complications of Vascular Access procedures ## Prevention **Prevention, cont.** * For high-risk patients, consider the experience of the clinician and consult an expert clinician for insertion. * Maintain vigilant awareness of needle depth and advancement if tip of needle cannot be tracked continuously by ultrasound. * If a central line is needed in a patient with an existing pneumothorax, place on the same side as the existing pneumothorax to avoid the risk of bilateral pneumothoraces. * Peripheral and femoral approach may be safer option for patient with pneumothorax due to fact that the needle never nears the thorax during insertion. ## Symptoms * May be asymptomatic * Sudden cough * Chest pain * Shortness of breath * Hypoxia * Tachycardia * At time of insertion, practitioner may note air being aspirated into syringe when negative pressure applied. ## Treatment * Perform sliding lung assessment * Dependent on size and location * Chest radiography should be used to determine extent of pneumothorax * Small pneumothorax may resolve without treatment * Close observation for 24-48 hours may be indicated * Larger pneumothorax may require decompression via needle aspiration or chest tube * Monitor the patient closely * If symptoms of tension pneumothorax, do not leave patient, call for help and gather supplies for needle decompression. ## D. Pneumothorax * A collection of air in the pleural cavity between the lung and the chest wall. ## E. Hemothorax * A collection of blood in the pleural cavity between the lung and chest wall. ### Causes * Introducer or catheter may transect or erode through vein wall allowing blood to enter pleural space ### Prevention * Use ultrasound (US) guidance for all CVAD Insertions. * Avoid forceful insertions of dilator/sheath and catheter. * Constantly check for free sliding wire while advancing the dilator sheath. ### Symptoms * Dyspnea * Shallow and rapid breathing * Chest pain * Hypotension * Tachycardia * Restlessness * Anxiety ## Treatment * May require needle aspiration and/or chest tube placement to remove blood and/or air. * Chest radiography or CT is the best way to determine the extent of the hemothorax * May require repair of injury to vein and transfer of the patient to a higher level of care * Monitor the patient closely ## F. Air Embolus * A blockage of blood supply caused by a significant amount of air entering into a blood vessel or the heart. ### Causes * Direct communication between environmental air and systemic venous circulation usually occurring during insertion or removal of CVAD. * May also occur as a result of fracture or detachment of catheter connections, inadequate priming of catheter lumens, and/or failure to clamp other lumens with opening to air, deep inspiration during insertion or removal. * Not priming or removing all air from _IV_ tubing or other devices completely prior to connection to CVAD. ### Causes, continued * Air embolism is less common with insertion or removal of _PICCs_ due to longer length, small internal lumen size and insertion point usually below level of heart. Can occur during use of _PICC_. ### Prevention * Position patient in supine or Trendelenburg position during insertion and removal of any _CVAD_. High risk if the patient is being mechanically ventilated. * Never remove upper body _CVAD_ with patient in upright position. * If the patient is alert and compliant, ask them to perform a Valsalva maneuver, hum or hold their breath during _CVAD_ removal. * Occlude hub of the needle, dilator, and catheter whenever possible during insertion. * Treat hypovolemia prior to catheter placement, if possible. * Once the catheter is in place, use luer lock connections to minimize the risk of air entry through the catheter. * At time of removal place petroleum-based gauze and occlusive dressing immediately over site. ### Symptoms * Dyspnea * Substernal chest pain * Sense of "Impending doom" * Severe cases may manifest as hemodynamic collapse and/or acute vascular insufficiency of specific organs such as the brain * Confirming air embolism diagnosis is difficult without fluoroscopy. Treat if suspected. ### Treatment * Place patient on left side in Trendelenburg position; this may restore blood flow by allowing air emboli to migrate superiorly to non-obstructing position. * Quickly identify the source of air entry and act to prevent further air embolization. * If catheter in situ, do not remove. Attempt to aspirate air from catheter. * Administer oxygen and notify licensed independent practitioner as soon as possible.