VASCULAR ACCESS DEVICES

VASCULAR ACCESS DEVICES

Introduced in early 1980s

Allow medications to be delivered directly into larger veins

Less likely to clot

Can be left in for longer periods of time

TYPES OF VASCULAR ACCESS

Central Venous Catheters› Tunneled CVC’s:

Hickman Broviac Groshong

› Percutaneous CVC’s: Ports PICC Lines

Fistulas

TUNNELED CATHETERSSurgically insertedTunnel made through subcutaneous tissue (usually b/t clavicle and nipple)Tip inserted through cephalic, internal or external jugular and threaded into superior vena cavaHeld in place with Dacron cuff under skinPlacement verified through x-rayCan be single, double or triple lumen

TUNNELED CATHETERS Placement of Tunneled Catheters Tunneled Catheters

PERCUTANEOUS CATHETERS -PORTS

•First used in oncology patients in 1981; now 100,000 ports implanted yearly•Surgically implanted beneath skin, usually in chest region•Right side of chest preferable d/t anatomy (superior vena cava) – “kangaroo” pocket created for portal body•Accessed by IP, Huber, or other type of needle with deflective, non-coring tip

PORTS Placement of ports Port Images

Reasons for Ports Long term IV therapy Frequent blood transfusions or blood

draws Bone marrow transplant Protection of smaller vessels

Ports Advantages

› Decreased chance of infection – port sealed under skin

› Less interference with ADLs – no external components

› Less body image concerns (teens)

› Long usable life – up to 10 years (compared to <1 yr for PICC line)

Disadvantages› Needle access › Most expensive device

to place› Requires minor surgical

procedure for placement

› Can be difficult for patients to maintain

PERCUTANEOUS CATHETERS -PICC LINES

PICC – Peripherally Inserted Central Catheter

Inserted in interventional radiology or patient room by:

PhysicianPhysician AssistantNurse PractitionerCertified PICC nurse specialist

Placed in peripheral vein (basilic, cephalic or brachial) and advanced into superior vena cava or cavo-atrial junction

PICC LINES Healthcare providers often use ultrasound for placement followed by x-ray (fluoroscopy)to assure proper placement

Reasons for PICC Lines Reduced number of needle punctures Prolonged IV antibiotic treatment TPN nutrition Chemotherapy Repeated administration of blood or

blood products Venous blood samples Measurement of central venous

pressure

FISTULASUsed for dialysis in patients with renal impairment

Surgeon joins an artery and vein, bypassing capillaries, allowing blood to flow rapidly through the fistula

Created in the non-dominant arm

If vein quality is poor, grafts can be used

Takes approximately 4-6 weeks to mature

FISTULAS Formation of fistulas Aneurysm of fistula

FISTULAS

RadiocephalicBrachiocephalic

Most common fistula for hemodialysis Created in forearm near wrist Radial artery anastomosed to cephalic

vein

Often created if poor lower arm vessels or after failure of radiocephalic fistula

Created in arm near elbow Brachial artery anastomosed to cephalic

vein

FISTULAS Benefits:

› Lower infection rates

› Higher blood flow rates = more effective dialysis

› Lower incidence of thrombosis

Complications:› “Steal syndrome”

= cold limb, cramping, tissue damage

› Aneurysm d/t repeated needle insertion

› Thrombosis› Failure to mature

DIALYSIS

Click icon to add picture

Two needles inserted into fistula, one to draw blood, one to return it

References

Bartholomay, M., Dreher, D., Evans, T., Finn, S., Guthrie, D., Lyons, H., Mulligan, J., & Tyksienski, C. (n.d.) Nursing management of venous access devices: Non-tunneled catheters. Retrieved from http://www.mghpcs.org/EED_Portal/Documents/Central_Lines/CL_Module7.pdf

Nursing Link (2012). The use and maintenance of implanted port vascular access devices. Retrieved from http://nursinglink.monster.com/training/articles/302-the-use-and-maintenance-of-implanted-port-vascular-access-devices

Queensland Vascular (n.d.) Vascular and endovascular surgery. Retrieved from http://www.qldvascular.com.au/renal-clinic.html

Roe, E. J., III, & Turner-Lawrence, D. (2012). Central venous access via subclavian approach to the subclavian vein. Retrieved from http://emedicine.medscape.com/article/80336-overview