Central Venous Access Devices CVADs Chapter 17 Copyright

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Central Venous Access Devices (CVADs) Chapter 17 Copyright © 2014 by Mosby, an imprint

Central Venous Access Devices (CVADs) Chapter 17 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Case Study • R. J. is a 54 -year-old African. American male who is

Case Study • R. J. is a 54 -year-old African. American male who is admitted to the hospital with a diagnosis of infective endocarditis. • R. J. will need IV access for extended antibiotic administration. • What type of IV access would be most appropriate for R. J. ? i. Stockphoto/Thinkstock Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CVADs • Catheters placed in large blood vessels • Subclavian vein, jugular vein •

CVADs • Catheters placed in large blood vessels • Subclavian vein, jugular vein • Three main types • Centrally inserted catheters • Peripherally inserted central catheters • Implanted ports Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CVADs • Permit frequent, continuous, rapid, or intermittent administration of fluids and drugs •

CVADs • Permit frequent, continuous, rapid, or intermittent administration of fluids and drugs • Allow for giving drugs that are potentially vesicants • Used to administer blood/blood products and parenteral nutrition Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CVADs • Used for hemodynamic monitoring • Useful for patients with limited peripheral vascular

CVADs • Used for hemodynamic monitoring • Useful for patients with limited peripheral vascular access or need for long-term vascular access Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

CVADs • Advantages • Immediate access • Reduced venipunctures • Decreased risk of extravasation

CVADs • Advantages • Immediate access • Reduced venipunctures • Decreased risk of extravasation • Disadvantages • Increased risk of systemic infection • Invasive procedure Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Centrally Inserted Catheter • Inserted into a vein in the neck, chest, or groin

Centrally Inserted Catheter • Inserted into a vein in the neck, chest, or groin with tip resting in the distal end of the superior vena cava • Nontunneled or tunneled • Dacron cuff stabilizes catheter and decreases incidence of infection Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Centrally Inserted Catheter • Single, double, triple, or quad lumen • Examples of long-term

Centrally Inserted Catheter • Single, double, triple, or quad lumen • Examples of long-term (tunneled) catheters • Hickman • Groshong Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Tunneled Central Venous Catheter Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Tunneled Central Venous Catheter Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Non-Tunneled Central Venous Catheter From: Nix: Williams' Basic Nutrition & Diet Therapy, Mosby, 2009,

Non-Tunneled Central Venous Catheter From: Nix: Williams' Basic Nutrition & Diet Therapy, Mosby, 2009, Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

PICC • Central venous catheter inserted into a vein in the arm • Single

PICC • Central venous catheter inserted into a vein in the arm • Single or multilumen, nontunneled • For patients who need vascular access for 1 week to 6 months • Cannot use arm for BP or blood draw Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

PICC • Advantages • Lower infection rate • Fewer insertion-related complications • Decreased cost

PICC • Advantages • Lower infection rate • Fewer insertion-related complications • Decreased cost • Complications • Catheter occlusion • Phlebitis Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

PICC Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

PICC Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Implanted Infusion Port • Central venous catheter connected to an implanted, single or double

Implanted Infusion Port • Central venous catheter connected to an implanted, single or double subcutaneous injection port • Port is metal sheath with self-sealing silicone septum Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Implanted Infusion Port Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Implanted Infusion Port Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Implanted Infusion Port • Drugs are injected through skin into port • Advantages •

Implanted Infusion Port • Drugs are injected through skin into port • Advantages • Good for long-term therapy • Low risk of infection • Cosmetic discretion • Care requires regular flushing Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Case Study The IV team nurse just completed insertion of a PICC line into

Case Study The IV team nurse just completed insertion of a PICC line into R. J. ’s right basilic vein. i. Stockphoto/Thinkstock 1. What must you do before administering the IV antibiotic via the PICC line? 2. For what complications will you monitor R. J. ? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Complications • Catheter occlusion • Clamped or kinked catheter • Tip against wall of

Complications • Catheter occlusion • Clamped or kinked catheter • Tip against wall of vessel • Thrombosis • Precipitate buildup in lumen Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Complications • Embolism • Catheter breaking • Dislodgement of thrombus • Entry of air

Complications • Embolism • Catheter breaking • Dislodgement of thrombus • Entry of air into circulation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Complications • Infection • Contamination during insertion or use • Migration of organisms along

Complications • Infection • Contamination during insertion or use • Migration of organisms along catheter • Immunosuppressed patient Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Complications • Pneumothorax • Perforation of visceral pleura • Catheter migration • Improper suturing

Complications • Pneumothorax • Perforation of visceral pleura • Catheter migration • Improper suturing • Trauma, forceful flushing • Spontaneous Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Case Study 1. What can you do to maintain patency of the PICC? i.

Case Study 1. What can you do to maintain patency of the PICC? i. Stockphoto/Thinkstock 2. What will you teach R. J. about proper care of the PICC line? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Management • Inspect catheter and insertion site • Assess pain • Change dressing

Nursing Management • Inspect catheter and insertion site • Assess pain • Change dressing and clean according to institution policies • Transparent semipermeable dressing or gauze dressing • Chlorhexidine preferred cleansing agent Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Management • Change injection caps • Have patient turn head to opposite side

Nursing Management • Change injection caps • Have patient turn head to opposite side • Valsalva if no clamp • Flushing is important • Normal saline prefilled syringe • Use only 10 ml syringe or larger • Flushing technique important Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Case Study i. Stockphoto/Thinkstock • R. J. completes his required IV antibiotic regimen and

Case Study i. Stockphoto/Thinkstock • R. J. completes his required IV antibiotic regimen and returns to the clinic for removal of his PICC line. • Describe how you will remove the PICC line. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Removing CVADs • Should be done according to institution policy • Gently withdraw while

Removing CVADs • Should be done according to institution policy • Gently withdraw while patient performs the Valsalva maneuver • Apply pressure • Ensure that catheter tip is intact • Apply antiseptic ointment and dressing Copyright © 2014 by Mosby, an imprint of Elsevier Inc.