Others - CVAD

Question 1

Peripheral access - 2

Answer 1

1. Anything which enters the periphery
2. e.g. Peripheral Venous Cannula (PVC) or Midline

Question 2

Central Venous Access – 2

Answer 2

1. The CVAD tip location with the greatest safety profile in adults and children is the Cavo atrial Junction.
2. The further within the Vena Cava, the less likely thrombocytopenia is to occur

Question 3

Why use Central venous access – 6

Answer 3

1. Volume resuscitation
2. Long course of antibiotics
3. Parenteral nutrition
4. Systemic anticancer treatment
5. Vesicant or high osmolar medicines
6. Difficult IV access

Question 4

Options - 5

Answer 4

1. Acute Central Venous Catheter
2. Femoral Central Venous Catheter
3. PICC (Peripherally Inserted Central Catheter)
4. Tunnelled Central Venous Catheter
5. Implanted Port

Question 5

Acute CVC (Central Line) – 5

Answer 5

1. Aseptic Conditions
2. Multi-lumen- allowing for multiple medications
3. Rapid Fluid resuscitation
4. Central Venous Pressure monitoring
5. 10-14 days – risk CLABSI (central line associated blood stream infection)

Question 6

Femoral CVC (Femoral Line) – 4

Answer 6

1. Only used if for any reason the IJ or sc vein cannot be accessed
2. Risk of Tissue damage, Infection or SVC Syndrome
3. Compressible
4. Patient must be non-ambulant

Question 7

PICC 3 Choices

Answer 7

Basilic – friendly, it is usually the bigger of the veins, more direct route into the axillary vein, no acute angulations
Brachial – close to the artery!
Cepahalic – NO- smaller and acute angle into the Axillary vein.

Question 8

Tunnelled central venous catheters – 4

Answer 8

1. Incision into chest wall, tunnel into skin
2. Place under skin
3. Can stay in for years, easy to maintain
4. Can be infected

Question 9

Implanted port - 3

Answer 9

1. Tunnelled under skin
2. When administration occurs, needle is inserted into port
3. Provides normal life, can bathe or swim

Question 10

Device related factors – 4

Answer 10

1. Duration of Therapy
2. Frequency of Access
3. Flow Rates required
4. Number of Lumens Required

Question 11

Early/Procedural Complications – 6

Answer 11

1. Arterial Puncture
2. Bleeding
3. Nerve Damage
4. Pneumothorax – puncture of plural cavity, lung deflates
5. Air Embolus
6. Malposition

Question 12

Late complications – 4

Answer 12

1. Infection - localised/systemic. Flora on skin can cause infection, so skin is cleaned with chlorohexidine & OH.
2. Upper Limb DVT (Thrombus)
3. Occluded lines
4. Persistent withdrawal occlusion/Fibrin Sheath

Question 13

Adv Vs Dis of CVAD - 4

Answer 13

1. Risk vs Benefit
2. Device should be the smallest diameter suitable for the job. Least number of lumens.
3. Should only stay in as long as it is necessary.
4. Allows for repeated blood sampling, large volume fluids, saves patients having repeated cannula insertions.