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How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?

1 Jahrs vor
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Short-term CVADs are devices in situ for a minimum period of days and possibly longer if tunnelled. They are reviewed daily for continued need and removed as soon as they are no longer required.rr

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Advantagesr Disadvantagesr                                                                                  
  • may be used for variety of purposes: administration of high volume, irritative, multiple incompatible solutions and medications, central venous pressure monitoring, blood sampling
  • may be inserted for emergent insertions
  • available in heparin or antimicrobial impregnated materials to reduce the risk of infection and thrombosis
  • relatively easy to insert and remove if not tunnelled
  • tunnelled – potential to reduce the risk of infection and dislodgementrr
  • can be inserted bedside
  • short-term use
  • can be associated with a higher risk of infections compared to other CVADs
  • require weekly dressings

Centrally inserted central venous catheters (CICCs) or central venous catheters (CVCs)

Centrally inserted central catheters (CICCs) or central venous catheters (CVCs) are short-term devices inserted via the veins in the neck or chest including the jugular, subclavian, or axillary veins.

Features of these catheters include:

  • single or multiple lumens allowing for the administration of multiple, high volume or concurrent incompatible solutions or medications
  • non-tunnelled so the catheter enters the vein near the skin puncture site or tunnelled catheter where the skin exit site is a distance from the venepuncture for optimal dressing and securement application
  • coated, bonded or impregnated with heparin, antimicrobials, silver, antiseptic
CICC/CVC- with chlorhexidine (CHG) disc, subcutaneous and adhesive external securement device (ESD) and bordered semipermeable dressingTunnelled CICC/CVC- with CHG disc, subcutaneous and adhesive ESD and bordered semipermeable dressing
How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?
How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?

© E. Alexandrou 2020

© E. Alexandrou 2020

Femorally inserted central catheters (FICCs)

Femorally inserted central catheters (FICCs) are short-term CICCs/CVCs inserted via the femoral vein. The catheter tip is located in the inferior vena cava.r

These catheters can have single or multiple lumens, and are non-tunnelled or tunnelled for optimal dressing and securement application.

The femoral veins should be avoided for planned insertions due to the risk of infection and thrombosis.rrrr

Tunnelled FICC – exit site tunnelled to mid thigh, with CHG disc, subcutaneous and adhesive ESD, and bordered semipermeable dressing
How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?

© E. Alexandrou 2020

Apheresis catheters

Apheresis catheters are open, large bore catheters (10-18.5 Fr for adults and 6-8 Fr for paediatric patients) that tolerate high flow rates for: therapeutic procedures for treatment of chronic conditions, e.g. plasmapheresis, erythropheresis, photopheresis; and cellular collections (to produce a product), e.g. stem cells, lymphocytes, granulocytes.r

These catheters can have a single, double or triple lumen – the third lumen has a smaller diameter to allow for administration of medications or fluids.

Advantagesr Disadvantagesr
  • large bore permits reliable high blood flow rates
  • longer dwell time if tunnelled cuffed catheter
  • can be inserted at the bedside
  • short-term use for non-tunnelled catheter
  • requires different locking solutions, specific volumes/concentrations
  • made of rigid material- may impact patient comfort and securement may be challenging
  • require weekly dressings and locking
  • impact on body image
  • patient discomfort
Apheresis catheter –  triple lumen, low internal jugular approach with CHG disc, subcutaneous and adhesive ESD, bordered transparent dressingApheresis catheter  –  low internal jugular approach with CHG disc, adhesive ESD and bordered semipermeable dressing
How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?
How would the nurse assess a patient’s central venous access device (cvad) for damage or breakage?

© E. Alexandrou 2020

© E. Alexandrou 2020

How do you assess the Cvad site for other complications?

The nurse should assess the CVAD site visually to observe skin color and comparative extremity size and use palpation to detect swelling, warmth, pain, tenderness, and drainage.

What are your nursing responsibilities for patients with CVADs?

The CVAD bundle focuses on five key elements: hand hygiene, maximal sterile barrier, chlorhexidine antiseptic, catheter site selection, and daily evaluation of the need for the device. Once the CVAD is placed, evidence-based care and maintenance are the responsibility of the nurse.

Which action would the nurse perform to best ensure effective insertion of venous access device into a patient's arm?

1. Which action would the nurse perform to best ensure effective insertion of a venous access device into a patient's arm? Anchor the vein by placing a thumb 1 to 2 inches below the site. Insert the device tip at a 45-degree angle distal to the proposed site.

How can the nurse minimize the risk of dislodging the central venous access device Cvad catheter when changing a dressing?

Lower the patient's head during the dressing change..
Remove the transparent dressing or tape and gauze in the direction of catheter insertion..
Apply skin protectant while the stabilization device is off..

nurse assess patients central venous access device cvad damage breakage

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