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An Introduction toCENTRAL VENOUS ACCESS DEVICES
Originally Created By: Sheila Elliott MN, RN
Revised By: Tina Haayer, RN, BScN
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Objectives:
What is the definition of a CVAD?
What are the different types of CVADs?
Why are CVADs used?
How do you care for the different types of CVADs?
What are the complications associated with CVADs?
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A venous access device whose tip lies within the lower third of the vena cava (superior or inferior) or the right atrium. (Dougherty, 2006)
Definition of CVAD
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Placement of CVAD
Catheter tip in superior vena cava
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PICC – Peripherally Inserted Central Catheter
Short-term, non-tunnelled CVAD - inserted directly into a central vein
Long tern, tunnelled CVAD – inserted under the skin
IVAD – Implanted Venous Access Device
Types of CVAD
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Peripherally Inserted Central Catheter
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PICC Inserted in antecubital
region and threaded into central circulation
Very soft and flexible, easily damaged
Lower risk of infection No BP’s or venipuncture
on that arm May be removed by RN
once observed Single or double lumen May be an open or a
closed system
Tip
Insertion
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(2) Types of Tips for PICCs
Open-endedNon-Groshong
Closed-endedGroshong
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Short-term, Non-tunnelled Central Catheter
Inserted into jugular, femoral or subclavian vein
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Long-term, Tunnelled Central Catheter
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Implanted Venous Access Device
Left in place until treatment complete, or complications occur
Located beneath the subcutaneous tissue
Appears as a palpable protrusion under the skin
Lower risk of infection May only be accessed
with a non-coring needle Needles to be changed
every 7 days, or every day if infusing TPN/blood products
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IVAD
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Reliable for patients requiring long term access (eg: chemotherapy, TPN)
Emergency access and for rapid infusion of fluids or blood products
To monitor central venous pressure To provide venous access for patients who
have poor peripheral venous access Patient preference
Why Use A CVAD?
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ADVANTAGES DISADVANTAGES
Reliable long term access
Used for multiple blood samples
Used for blood products, meds, TPN & fluids
Removes need for constant venipuncture or peripheral punctures
↑ risk of infection ↑ risk of thrombus Exposes patient to risk
during insertion (pneumothorax)
Can affect body image Can be traumatic to
patient and may require general anesthetic for insertion
(Dougherty, 2006)
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Prevention of infection
Maintaining patency
Preventing damage
Key Principles In CVAD Management
These (3) priorities are the same
whichever type of CVAD is in place!
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Strict handwashing Use sterile technique Change dressings as recommended Occlusive dressing over exit site Keep system closed as much as possible Change tubing, solutions and injection caps
as recommended Monitor for early signs of sepsis
Preventing Infection
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Cleaning Site with Chlorhexidine Swabs
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Transparent Dressing Over Insertion Site
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Maintaining Patency
Patency is the ability to:◦ Infuse through a catheter◦ Aspirate blood from a catheter
Maintain patency with saline flushes:◦ Prior to and after meds, TPN, etc.◦ Before and after blood draws◦ Refer to hospital policy
Methods of flushing include:◦ Turbulent or pulsatile flush (creates turbulence and ↓
potential for debris to stick to inside or tip of catheter)◦ Positive pressure (prevents backflow of blood into end of
catheter)
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CLC 2000 Positive Pressure Cap
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Preventing Damage
Proper securement of CVAD is vital in preventing the following complications:◦ Catheter migration◦ Phlebitis◦ Damaged catheter
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L. Dougherty. (2006). Central Venous Access Devices: Care and management.
Oxford, UK: Blackwell Publishing Ltd.
References