Central Venous Access Devices (CVAD) - Chapter 17 Review

Introduction

• CVADs are catheters placed in large blood vessels, such as the subclavian or jugular veins.
• Used for patients needing frequent or special vascular access.

Types of Central Lines

1. Centrally Inserted Catheters
2. Peripherally Inserted Central Catheters (PICCs)
   • Inserted by specially trained nurses.
3. Implanted Ports

Uses of Central Catheters

• Administration of fluids and drugs, including vesicants.
• Blood or blood products, parenteral nutrition.
• Hemodynamic monitoring and venous blood sampling.

Indications

• Limited peripheral vascular access.
• Long-term vascular access needs.

Insertion Sites

• Neck, chest (subclavian, jugular), groin (femoral).
• Catheter can be non-tunneled or tunneled.

Advantages

• Immediate access to the central venous system.
• Reduced need for multiple venipunctures.
• Decreased risk of extravasation injury.

Disadvantages

• Increased systemic infection risk.
• Invasiveness of procedure.

Multi-lumen Catheters

• Allow different therapies simultaneously (e.g., incompatible drugs without mixing).

Specific Long-term Catheters

• Hickman Catheters: Require clamps.
• Groshong Catheters: Valve opens with fluid withdrawal/injection, stays closed otherwise.

Peripherally Inserted Central Catheters (PICCs)

• Inserted in arm veins, ending in superior vena cava.
• Usage duration: a week up to 6 months, possibly longer.
• Advantages: Lower infection rate, fewer complications, cost-effective, bedside insertion.
• Complications: Catheter occlusion, phlebitis.

Implanted Infusion Ports

• Consist of a catheter and subcutaneous injection port.
• Good for long-term therapy with low infection risk.
• Requires regular flushing to avoid sludge formation.

IV Infusion Techniques

• Flushing: Use normal saline, check for resistance, observe patient feedback.
• Infiltration Indicators: Swelling, burning, coldness at site.
• Complications: Thrombus, embolism.

Complications and Management

• Catheter Occlusion: Symptoms include sluggish infusion; manage by repositioning, flushing, or using anticoagulants.
• Embolism: Prevent entry of air into circulation, manage with position changes, oxygen.
• Infection: Monitor for signs, use sterile techniques, proper site maintenance.
• Phlebitis/Thrombophlebitis: Manage with discontinuation, elevation, compresses.
• Pneumothorax: Risk with central line insertion.

Catheter Maintenance

• Dressing Changes: Use sterile technique, observe site regularly.
• Flushing Techniques: Push-pause technique for lumen patency.
• Pressure Clamping: Importance of correct application.

Removal of CVADs

• RN with competencies may remove PICCs and non-tunneled catheters.
• Involves suture removal, Valsalva maneuver during withdrawal.
• Apply pressure and antiseptic ointment post-removal.