Central Venous Access Devices PDF

Central Venous Access Devices AKA: CENTRAL LINES, CENTRAL VAD’S  What are they?  Central venous access devices (CVAD)are catheters placed in a large vein (subclavian, jugular, or femoral)for people who need frequent, long term, or special access to the vascular syste...

Central Venous Access Devices AKA: CENTRAL LINES, CENTRAL VAD’S  What are they?  Central venous access devices (CVAD)are catheters placed in a large vein (subclavian, jugular, or femoral)for people who need frequent, long term, or special access to the vascular system  Some Examples: chemotherapy, long-term administration of antibiotics, hemodialysis, nutritional replacement  Advantages  Immediate access to the central venous system  Decreased amount of venipuncture  Allow access for people with limited peripheral access  Hemodynamic monitoring  Disadvantages  Increased risk of infection  Central line-associated bloodstream infection (CLABSIs)  Types of CVAD’s  Centrally Inserted Catheters  Tunneled or non-tunneled  Peripherally Inserted Central Catheters (PICC)  Implanted Infusion Ports  Tunneled Catheters Fig. 17-18. Tunneled central venous catheter. Note tip of the catheter in the superior vena cava.  Tunneled Catheters  For long-term use  Insertion location:  Into a vein in the neck or chest (subclavian or jugular) or groin (femoral)  A portion of the catheter is tunneled in the subcutaneous tissue separating the point of entry from where the catheter enters the vein  Dacron cuff stabilizes catheter  Scar tissue keeps catheter in place and provides a barrier to organisms  May have single, double, or quad lumens  Have a lower risk for infection than non-tunneled catheters  Requires care and cleansing  No dressing is needed because entrance into skin and vein are separate and tissue granulation provides a barrier  Usually inserted by surgeon in out patient setting, operating room, or interventional radiology  Ensure x-ray verification of tip placement prior to use  Nontunneled Catheters  For short term use only  Insertion location:  Into a vein in the neck or chest (subclavian or jugular) or groin (femoral)  Tip of catheter in the superior vena cava  Dressing changes/Site care  Gauze dressing – change every 48 hours and as needed  Transparent dressing – change every 5-7 days and as needed  May have single, double, or quad lumens  Can be placed at the bedside in the emergency department, intensive care unit, or other settings in emergency situation  Ensure x-ray verification of tip placement prior to use Peripherally Inserted Central Catheters (PICC)  Peripherally Inserted Central Catheters (PICC)  Used for patients that need vascular access for 1 week to 6 months but can stay in for 12 months  Insertion location:  Arm – usually the cephalic or basilic vein  Tip should be located in the lower one-third of the superior vena cava  Can be single or multi-lumen  Nontunneled  Can be inserted at bedside or outpatient by a specially trained RN  Confirm placement with an x-ray  Assess site for redness, swelling, drainage, tenderness, and condition of the dressing  Phlebitis can occur within 7 – 10 days after insertion  Change dressing every 7 days or as needed  Do not use the arm with the PICC to obtain a blood pressure or draw blood  Instruct patient not to immerse in water – cover dressing site during showers Implanted Vascular Access Device Implanted Vascular Access Device  https://www.youtube.com/watch?v=xVebbriPQAs  Copy link and paste on YouTube search bar to watch video  Implanted Infusion Ports  Long term use – 1 year or more  Commonly used for chemotherapy  Insertion location:  Surgically implanted into chest wall pocket  Catheter is inserted into subclavian vein  Catheter tip is located in superior vena cava  Only specially trained personnel should access port  Accessed with special Huber-point needle  Port has a self-sealing silicone septum  Drugs are injected through skin into port, then reservoir slowly releases drug into the bloodstream  Regular flushing is required  Catheter tip and port can become dislodged  Report swelling at the port site, unrestricted movement of the port, inability to access port, pain on the affected side in the neck or ear Nursing Management  Inspect catheter and insertion site.  Assess pain.  Change dressing and clean according to institution policies.  Will review procedure in lab  Change injection caps.  Flushing is important Removing Central Lines  Should be done according to institution policy.  Only done by nurses who are specifically trained  Gently withdraw while patient performs the Valsalva maneuver.  Apply pressure.  Ensure that catheter tip is intact.