Purpose: Pt w/ chronic disease need long-term iv therapy: drug, nutrition, fluid, antibiotics, chemo, and obtain blood. CVAD is usually used for long-term purposes vs peripheral expired within 4 days of insertion.
Central line catheter rest at the tip of the superior vena cava- nearby the R. atrium. X-ray needs to be performed to confirm the location site. DO NOT put anything on the central line until location confirmation.
Central line misplacement will cause complications with cardio and pulmonary such as; pneumothorax, pneumomediastinum, chylothorax, tracheal injury, injury to the recurrent laryngeal nerve, air embolus, arterial injury, venous injury, bleeding, and hematoma, arrhythmia, and cardiac arrest.
Complication w/ CVAD
Infection = sepsis
occlusion of line = air embolism= hypotension, dyspnea, and weak pulse
pneumothorax: chest pain, dyspnea, cyanosis
Thrombosis: chest pain and dyspnea
Types of CVAD
Non-tunneled central venous: Temporarily used purpose and the catheter are single or muti-lumen. placement are; subclavian, jugular, and least prefer is the femoral vein. Flush with Normal Saline. 10 ml or higher syringe.
Peripheral insertion central catheter (PICC)- Duration 6month or longer. Placement is; superficial vein in the antecubital cephalic and basilic vein. Flush w/ Normal Saline 10ml or higher syringe.
Implanted ports ( Chemo-port or port-a-cath) : Duration 1 year. Surgical placement with access using the Huber needle, 20 gauge 1′ to 1 1/2 inch length. MUST BE FLUSH W/ HEPARIN not Normal Saline.
Tunneled Catheter ( Hickman, Broviac, and Groshong) Duration 1 year. Surgical placement subcutaneously- prevention infection. FLUSH W/ Heparin.
Hemodialysis Catheter ( Quinton or Perma): Temp used for hemodialysis and usually inserted by a nephrologist. Dual lumen. Placement Subclavian or femoral vein.
Midline Catheter 8″ ( not peripheral or CVAD, but is treated as a CVAD)- DO not draw blood or infuse vesicant, need sterile technique insertion, duration 4wk, similar to PICC but shorter. insertion in peripherally into the basilic or cephalic vein for hemodilution.
Triple Lumen CVAD Line
Promximal = blood
Medial= TPN
Distal = Fluid ( such as cystalloid)
CVAD Insertion
Insertion by MD at bedside w/ RN assistance. Sterile procedure. Stabilization device used or sutured. No infusion until X-Ray confirms placement.
Dressing Change
Follow hospital policy or need to be clean. Before performing dressing change- pt. MUST be a bath with Chlor wipes from neck to foot.
- neck, shoulder, chest
- bilaterial arm and hand
- abdomen then groin and perineum
- bilateral leg and foot
- back of neck, back, and buttock
Preparation of dressing change do not need MD order; follow hospital policy, PRN, or if blood contaminated the cap ( cap will need to change).
Material
•A central line dressing kit contains: 1 mask, 1 alcohol prep, 1chlorhexidine prep, sterile gloves, tape, transparent dressing, alcohol swab, scissors
•Clean cloves: to remove Drsg
•Med cup with cleansing gel
•1 mask (may want to take 2 : you and pt)
•Garbage container •Pen to date and sign
•3 alcohol pads •3 Clave needless caps
•3 curos antibacterial caps
•3 syringes of 0.9 normal saline
Skin Assessment
•Phlebitis •Infection • •Infiltration • •Sutures
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