care of patient with cvc petra sedlarova, renata vytejckova, jana hermanova
TRANSCRIPT
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Care of patient with CVC
Petra Sedlarova, Renata Vytejckova, Jana Hermanova
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Central venous access
Access into blood stream via central vein
The distal end of the catheter ends in superior vena cava
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Historical milestones
1929 – Werner Forssmann – the first to insert CVC (Nobel prize 1956)
1950 – Aubaniac – first cannulation of subclavian vein
1953 – invention of Seldinger technique (trocar, guidewire, sheath)
70s of 20th century – development central venous catheter associated with parenteral nutrition
The end of the 70s – clear guidelines on indication and contraindication of using CVC
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Indications Serious condition with collapsed
peripheral veins Severe edema of extremities Long term treatment Long term parenteral nutrition Administration of high osmolarity
solutions Administration of vesicants CVP measurement Extracorporeal elimination methods
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Contraindications
Serious coagulopathy Patient’s refusal
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Types of catheters
Non-tunneled (short term) Swan – Ganz Catheter for hemodialysis
Tunneled (long term) Hickmann catheter Implantable venous port PICC
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Swan - Ganz
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Hickmann catheter
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PICC
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PORT
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Insertion site: Superior vena cava
Subclavian vein Internal jugular vein External jugular vein Basilic vein Cubital median vein
Inferior vena cava Femoral vein
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V. Jugularis interna
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Material features
Hydrophilic Smooth surface should prevent thrombus
formation Anti infectious
Silver coated ATB coated
Silikon Vialon Polyurethan
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Other classification Single lumen Multiple lumen
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Catheter insertion
Puncture technique most common Sterile procedure - set up sterile field,
insertion kits are used Local anesthesia (1% trimekain, lidokain,
EMLA), occasionally general anesthesia Peripheral venous catheter Informed consent Monitoring
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Seldinger technique
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Check correct placement
By the length of the inserted catheter X ray Blood aspiration
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Start treatment
Only after the placement has been verified by X ray
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Possible complications
Pneumotorax
Bleeding into mediastinum
Puncture of a. subclavia
Hemotorax
Pulmonary embolism
Infection
Thrombosis
Damage of the vein wall
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Patogenesis of infections
Intraluminal infection Extraluminal infection Endogenous infection
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Factors contributing to infection
Health condition of the patient Skin condition at the insertion site Location of insertion site
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Contributing factors - location
V. Femoralis Close to genitals Friction, movement
V. jugularis Movement Hair, facial hair, airway Possible kinking
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Infection signs
Local – at the insertion site
General – fever, malaise
Suspect catheter infection - Draw blood cultures during fever
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Preventive measures
Aseptic approach during insertion and care
Proper hand hygiene, gloves Minimize the number of lumens and
connections Minimize the length of insertion Use safe connectors (luer) Proper location of insertion site
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Care of the catheter Always sterile approach Secure the catheter (stitches, sterile strips) Sterile dressing Regular dressing changes Regular changes of the tubings Minimize the number of connections Maintain the patency Needleless connections Clave, Q-syte, Posiflow
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Dressing changes
Sterile equipment Gloves, face mask depending on the
type of the catheter Alcohol desinfection Dressing according to the guidelines
Transparent dressing Nontransparent dressing
Assessment of the insertion site
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Taking blood samples
Syringe Vacuum system Procedure
Stop all infusions Discard first 10 to 20
ml of blood Draw the samples Flush with NSS
Possible complications
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Removing catheter
Sterile procedure Compression of the insertion site Cut off the distal end of the catheter, send to
microbiology lab Monitor for bleeding