Download Central Venous Access Devices (CVADs): Types, Indications, Complications, and Nursing Care and more Exams Nursing in PDF only on Docsity!
NSE 22 1 WEEK 5 CVAD WITH COMPLETE SOLUTIONS 100%
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what is a CVAD? Central venous access devices (CVAD) are hollow catheters that have a hub at one end and a tip that terminates in the central circulatory system in a large blood vessel
when are CVADs used? when there is a need for rapid, continuous, or frequent administration of fluids and medications
what are indications for CVADs?
- medication administration
- blood transfusions
- blood sampling
- hemodialysis
- nutritional support (TPN)
- to give large volumes of fluid (ie. to replace fluid loss that can occur with burns or shock)
what is the purpose of a non-tunneled CVAD? inserted into subclavian, internal jugular and femoral veins
what is the advantage of a non-tunneled CVAD? can be used for short term and emergent access needs
what is the disadvantage of a non-tunneled CVAD?
short term access increased risk of infections
what is the purpose of a tunneled CVAD?
- suitable for long term
- Catheter is tunnelled through subcutaneous tissue from an entry site with catheter is then advanced into superior vena cava (SVC)
- A synthetic cuff (ie. Dacron) is used to anchor the catheter
what is the advantage of a tunneled CVAD?
- can have multiple lumens to allow for concurrent administration of medications and/or blood sampling
- Synthetic cuff reduces risk of infection and dislodgement
- Does not require a dressing once site heals
what is the disadvantage of a tunneled CVAD?
- requires frequent heparin flushing
- requires surgical insertion and will have multiple wound sites to heal
what is the purpose of a Peripherally Inserted Central Catheter (PICC)?
- catheter is inserted in the basilic or cephalic vein at or just above the antecubital fossa and the tip sits in the superior vena cava
- can have multiple lumens
what is the advantage of a Peripherally Inserted Central Catheter (PICC)?
- needs to be surgically implanted
- requires special needle to access
- requires regular flushing
- risk of clotting and drug accumulation in port reservoir
- expensive device
- can be painful to access
what are clinical manifestations of CVAD?
- emboli
- infection
- catheter migration
- pneumothorax
- catheter occlusion
how to assess emboli? look for signs and symptoms of respiratory distress (ie. cyanosis, increased respirations, increased respiratory effort)
how to assess infection? Redness, warmth, edema, pain, drainage around insertion site - for local reaction
how to assess catheter migration?
unable to infuse or sluggish flushing and aspiration, patient report of gurgling sound in ear, change in external catheter length (increased or decreased length), swelling around neck and chest during infusion
how to assess pneumothorax? absent or decreased breath sounds on auscultation, signs and symptoms of respiratory distress present (ie. increased respirations and respiratory effort, cyanosis), uneven chest rise
how to assess catheter occlusion? unable to or sluggish with aspiration or flushing swelling at insertion site or anywhere distal to the catheter tip
what are CLABSI infections? Central Line Associated Blood Stream Infections
what measures can be taken to prevent CLASBI? proper aseptic technique with insertion, strict hand hygiene, appropriate cleansing techniques, and following organizational maintenance protocols or care bundles
how to assess site inspection?
- Check for signs of infection, such as redness, swelling, warmth, pain, tenderness, or discharge at the insertion site.
Transparent semi-permeable dressing is preferred to allow for site to be observed. Gauze may be placed under dressing if there is bleeding present
what kind of cleaning solution is preferred? Chlorhexidine-based cleaning solution is preferred
when are injection cap changes completes? as per organizational policies or when damaged. Patient should turn their heads to opposite side of insertion site during the cap change. Clamp catheter if able or patient should be supine and perform Valsalva maneuver to prevent air embolism
what IPAC measures are in place for CVAD?
- Observe adherence to aseptic technique during any manipulation of the CVAD
- Use of sterile technique with dressing changes and site cleaning
- Friction with chlorohexidine-based solution around insertion site to minimize infection risk
- Monitor for systemic signs of infection, such as fever, chills, or malaise
what should you evaluate patient on? the patient's understanding of CVAD care, signs of complications, and when to seek medical help
