Stephanie CunninghamAmy Waters

Central Venous Access Devices

5 Must Know Facts About CVAD’s

• 1) What are CVAD’s?• 2) What are CVAD’s used for?• 3) How are these devices put in?• 4) What are the complications related to

CVAD’s?• 5) What are the signs and symptoms of

these complications?

Central Venous Access Devices• Catheters that are placed in large blood

vessels (e.g., subclavian vein, jugularvein) of people who require frequentaccess to the vascular system.

• Central venous access can be achieved bythree different methods: centrally insertedcatheters, peripherally inserted centralcatheters (PICCs), or implanted ports.

• Centrally inserted catheters and implantedports must be placed by a physicianwhereas PICCs can be inserted by anurse with specialized training.

• CVADs permit frequent, continuous, rapid, orintermittent administration of fluids andmedications.

• They allow for the administration of drugs that are

potential vesicants, blood and blood products,and parenteral nutrition.

• They may also be used for hemodynamic

monitoring and venous blood sampling.

• These devices are indicated for patients whohave limited peripheral vascular access or whohave a projected need for long-term vascularaccess.

Central Line

• Centrally Inserted Catheter is inserted into a vein in theneck, chest or groin with the tip resting in the distal endof the superior vena cava.

• They are inserted with the aid of local or generalanesthesia.

• The other end of the catheter is either nontunneled ortunneled through subcutaneous tissue and exits througha separate incision on the chest or abdominal wall.

PICC• PICCs are central venous

catheters inserted into a vein inthe arm and advanced to aposition with the tip ending in thesuperior vena cava.

• They are intended for patientswho need vascular access for 1week to 6 months but can be inplace for longer periods of time.

• The technique for placement of aPICC line involves insertion of thecatheter through a needle withthe use of a guide wire or forcepsto advance the line.

Implanted Port

• The catheter is placed into the desiredvein and the other end is connected to aport that is surgically implanted in asubcutaneous pocket on the chest wall.

• Drugs are injected through the skin intothe port. After being filled, the reservoirslowly releases the medicine into thebloodstream.

• Implanted ports are good for long-termtherapy and have a low risk of infection.Because the port is hidden it offerscosmetic advantages.

• Great for patients with poor peripheralvenous access

Dressing Change• Gather supplies• Verify order, wash hands, ID patient• Explain procedure and sensations• Position patient in semi-fowlers• Take outside covering off of dressing tray and put on gloves and mask• Place mask on patient• Carefully remove and dispose of old dressing• Note any swelling, redness, tenderness, or exudate• Inspect cath and hub for any kinked or weakened areas. Also note length of catheter

exposed• Remove gloves and wash hands• Open dressing tray while maintaining sterility• Put on sterile gloves & prepare your sterile field• Using a vigourous back and forth motion clean around cath with chloraprep for 30

seconds and allow to dry for at least 1 minute• Apply biopatch• Apply transparent dressing (tegaderm)• Label dressing with date, time, and initals• Remove gear, discard soiled dressings and supplies, wash hands• DOCUMENT, DOCUMENT, DOCUMENT!

Dressing Change• Dressing should be changed at least every

7 days or earlier if it is no longer intact orvisibly soiled.

• Transparent dressing permits observationof site

CVAD’sComplications• Thrombosis• Dislodgement• Pneumothorax• Hemothorax• Occlusion• Cardiac Perforation• Infection

Signs & Symptoms• Shortness of Breath• Chest Pain• Dizziness• Anxiety• Palpitations• Fever• Swelling at Site• Redness at Site• Heat at Site• Drainage at Site• Moveable Port• Swishing• Gurgling

Thrombosis

Dislodgement

Pneumothorax

Hemothorax

Cardiac Perforation

Infection

Extravasation

• Hand Hygiene-# 1 intervention to prevent infection!• Aseptic Technique• Chlorhexidine Prep-Back & Forth Motion• EVP proves chlorhexidine is more effective than alcohol or iodine• EVP use of chlorhexidine reduces catheter related infections by

nearly 50% when compared to iodine.• Place mask on patient during dressing change• EVP non heparinize saline is an effective alternative to heparinized

saline and does not subject the patient to potential complicationsrelated to heparin

THE END