CVAD Flashcards by Hannah Holland

What is a CVAD?

Intravenous catheter or Infusion port

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Lumens

Diameter of the tube

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CVAD is designed to administer-

Meds, nutrients, IV fluids, and blood products through a central vein

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Distal catheter

blood draw, blood infusions, meds, CVP

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Proximal catheter

IV fluids, meds, blood draw

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Medial catheter

TPN, meds, IV fluids

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Catheters are inserted into __________ veins in central circulation with catheter tip ending in what?

Large
Ends in superior vena cava/ Rt atrium

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CVAD requires _________ confirmation

X-RAY

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CVAD is typically for ___________ to ___________ use

Moderate to long term

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The proximal catheter is closest to the

Heart

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Types of CVAD

Non-tunneled
Tunneled
Port-A-Cath

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What should you tell the patient before CVAD insertion

Purpose
Estimated length of time they will have CVAD
What to expect (sterile procedure at bedside or IR)

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Pt needs to be in trendelenburg position for CVAD insertion, why?

Enlarges vein, can help decrease chance of air embolism and allows easier access to the vein

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Non-tunneled are most commonly inserted directly into what vein?

Subclavian

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Non-tunneled CVAD are secured by what and where?

Sutures on outside the insertion site to the skin

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Non-tunneled is for acute, moderate to long term, so about ___ weeks

6 weeks

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Non-tunneled has a higher infection rate than tunneled, why?

Open to air, hanging out of skin

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Picc

Peripherally inserted central catheter

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Nurse can discontinue Non-tunneled, why?

Because it was not surgically implanted

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Which veins are used for PICC, IF what can be accessed?

Basilic or cephalic vein, if peripheral vein can be accessed

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Different types of tunneled CVAD

Broviac, Groshong, Hickman

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Tunneled CVAD are surgically tunneled where?

Beneath skin

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Tunneled CVAD are unique due to __________ _______ on the catheter

Dacron cuff

Dacron cuff is sutured in place (SQ tissue) initially then

Scar tissue secures itself around the cuff

Dacron cuff helps

Secure, prevent infection

Common sites of tunneled CVAD

Subclavial vein, IJ, femoral vein

Tunneled CVAD are chronic or

Long term (greater than 6 weeks)

Why can nurse not discontinue tunneled CVAD?

Must be surgically removed because of Dacron cuff

Implanted port is surgically implanted line

Underneath skin

Implanted ports are tunneled through

Jugular, subclavian, or cephalic/basilic vein

Implanted ports are long term, can be

Months to years

Implanted ports can be ________ or ________ ports

Single or dual

What are implanted ports for?

Chemotherapy

What needle is needed to access implanted ports?

Huber needle

Implanted ports are less

Restrictive

Always assess the CVAD site before

Any interventions (Site/sutures/dessing/date. Lumens/clamps/caps. Fluids/meds)

Always “_____________________” at least 15 seconds before accessing

Scrub the hub

Always program CVAD infusions to

A pump

Flush Lumens only using

10 mL flush syringes

When do you flush Lumens

Every shift After every medication After every blood draw

Dressing changes are 24 hours post

Insertion and q 7 days and PRN

CLABSI

Most common complication of CVAD Central line associated blood stream infection!!!

Signs and symptoms of CLABSI

Redness Drainage Swelling Discomfort at insertion site Fever Chills Tachycardia Increased WBC

Nursing interventions to prevent complications of CVAD

Strict asepsis NEVER touch with bare hands Clean injection ports with alcohol swab before every access Assessments and reporting concerns Dressing changes Pt/family teaching

Pneumothorax

Air in the pleural space outside of the lung “Collapsed lung”

Signs and symptoms of pneumothorax

Dyspnea Hypoxia Tachycardia Restlessness Cyanosis Chest pain Decreased breath sounds Obvious “chest deformity”

Nursing interventions for pneumothorax

Monitor vital signs Administer oxygen Notify physician,CN, RRT Prepare for chest tube, if indicated

Venous air embolism

Air entering the circulatory system

Signs and symptoms of venous air embolism

Acute dyspnea Chest pain Headache Confusion Hypotension Hypoxia Tachycardia

Nursing interventions for venous air embolism

Keep Lumens clamped Administer oxygen, monitor VS, pulse ox Place pt on left lateral side in trendelenburg position Stay with patient, notify physician

Occlusion

Lack of blood return or sluggish flow

Thrombosis

Clot that blocks the catheters lumen

Catheter rupture

May be caused by excessive force used while flushing and wrong flush syringe

Catheter migration

Displacement or lengthening of catheter

Why do you need to place patient on left lateral side in Trendelenburg position for venous air embolism?

We want to trap the air embolism in the **right atrium** so that it doesn’t leave the heart and go to circulatory system and then to the brain

If catheter does not have a blood return or will not flush, have patient try the following:

Deep breaths/cogh Raise arms overhead Sit/stand-up Change positions in bed Place in trendelenburg Administer altepaste