An Introduction toCENTRAL VENOUS ACCESS DEVICES

Originally Created By: Sheila Elliott MN, RN

Revised By: Tina Haayer, RN, BScN

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?

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

Placement of CVAD

Catheter tip in superior vena cava

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

Peripherally Inserted Central Catheter

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

(2) Types of Tips for PICCs

Open-endedNon-Groshong

Closed-endedGroshong

Short-term, Non-tunnelled Central Catheter

Inserted into jugular, femoral or subclavian vein

Long-term, Tunnelled Central Catheter

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

IVAD

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?

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)

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!

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

Cleaning Site with Chlorhexidine Swabs

Transparent Dressing Over Insertion Site

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)

CLC 2000 Positive Pressure Cap

Preventing Damage

Proper securement of CVAD is vital in preventing the following complications:◦ Catheter migration◦ Phlebitis◦ Damaged catheter

L. Dougherty. (2006). Central Venous Access Devices: Care and management.

Oxford, UK: Blackwell Publishing Ltd.

References