Central Venous Access Devices. Stephanie Cunningham Amy Waters

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1 Central Venous Access Devices Stephanie Cunningham Amy Waters

2 5 Must Know Facts About CVAD s 1) What are CVAD s? 2) What are CVAD s used for? 3) How are these devices put in? 4) What are the complications related to CVAD s? 5) What are the signs and symptoms of these complications?

3 Central Venous Access Devices Catheters that are placed in large blood vessels (e.g., subclavian vein, jugular vein) of people who require frequent access to the vascular system. Central venous access can be achieved by three different methods: centrally inserted catheters, peripherally inserted central catheters (PICCs), or implanted ports.

4 Centrally inserted catheters and implanted ports must be placed by a physician whereas PICCs can be inserted by a nurse with specialized training.

5 CVADs permit frequent, continuous, rapid, or intermittent administration of fluids and medications. They allow for the administration of drugs that are potential vesicants, blood and blood products, and parenteral nutrition. They may also be used for hemodynamic monitoring and venous blood sampling. These devices are indicated for patients who have limited peripheral vascular access or who have a projected need for long-term vascular access.

6 Central Line Centrally Inserted Catheter is inserted into a vein in the neck, chest or groin with the tip resting in the distal end of the superior vena cava. They are inserted with the aid of local or general anesthesia. The other end of the catheter is either nontunneled or tunneled through subcutaneous tissue and exits through a separate incision on the chest or abdominal wall.

7 PICC PICCs are central venous catheters inserted into a vein in the arm and advanced to a position with the tip ending in the superior vena cava. They are intended for patients who need vascular access for 1 week to 6 months but can be in place for longer periods of time. The technique for placement of a PICC line involves insertion of the catheter through a needle with the use of a guide wire or forceps to advance the line.

8 Implanted Port The catheter is placed into the desired vein and the other end is connected to a port that is surgically implanted in a subcutaneous pocket on the chest wall. Drugs are injected through the skin into the port. After being filled, the reservoir slowly releases the medicine into the bloodstream. Implanted ports are good for long-term therapy and have a low risk of infection. Because the port is hidden it offers cosmetic advantages. Great for patients with poor peripheral venous access

9 Dressing Change Gather supplies Verify order, wash hands, ID patient Explain procedure and sensations Position patient in semi-fowlers Take outside covering off of dressing tray and put on gloves and mask Place mask on patient Carefully remove and dispose of old dressing Note any swelling, redness, tenderness, or exudate Inspect cath and hub for any kinked or weakened areas. Also note length of catheter exposed Remove gloves and wash hands Open dressing tray while maintaining sterility Put on sterile gloves & prepare your sterile field Using a vigourous back and forth motion clean around cath with chloraprep for 30 seconds and allow to dry for at least 1 minute Apply biopatch Apply transparent dressing (tegaderm) Label dressing with date, time, and initals Remove gear, discard soiled dressings and supplies, wash hands DOCUMENT, DOCUMENT, DOCUMENT!

10 Dressing Change Dressing should be changed at least every 7 days or earlier if it is no longer intact or visibly soiled. Transparent dressing permits observation of site

11 CVAD s Complications Thrombosis Dislodgement Pneumothorax Hemothorax Occlusion Cardiac Perforation Infection Signs & Symptoms Shortness of Breath Chest Pain Dizziness Anxiety Palpitations Fever Swelling at Site Redness at Site Heat at Site Drainage at Site Moveable Port Swishing Gurgling

12 Thrombosis

13 Dislodgement

14 Pneumothorax

15 Hemothorax

16 Cardiac Perforation

17 Infection

18 Extravasation

19 Hand Hygiene-# 1 intervention to prevent infection! Aseptic Technique Chlorhexidine Prep-Back & Forth Motion EVP proves chlorhexidine is more effective than alcohol or iodine EVP use of chlorhexidine reduces catheter related infections by nearly 50% when compared to iodine. Place mask on patient during dressing change EVP non heparinize saline is an effective alternative to heparinized saline and does not subject the patient to potential complications related to heparin

20 THE END

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