Central Venous Access Devices

- Non-tunneled - Tunneled - Peripherally Inserted Central Catheter (PICC) - Implanted Vascular Access Device (IVAD)

- Shorter term use - Fast access - Higher rate of infection - 1-4 lumens - 6-8 inches in length - Inserted through a subclavian vein - Tip rests in superior vena cava (above the R atrium) - EXCEPT in a femoral CVAD: tip rests in the inferior vena cava

- Long term use - 1-3 lumens - Made of stronger medical grade silicon - Inserted by physicians in OR through subcutaneous tissue in chest - Usually exits around nipple level - 7-10 days after insertion, scar tissue forms around cuff (anchors catheter and stops microorganisms from migrating up tunnel)

- Intermediate term use (6 mo - 1 yr) - Lower rate of infection - Inserted in peripheral vein by physician or certified RN - Tip rests in superior vena cava (above the R atrium) - EXCEPT in a midline catheter: tip rests in a peripheral vasculature

- Long term use - Implanted under skin with no external parts - May last for over 2000 punctures - Accessed with non-coring Huber needle - RN with special training to access port - Often seen in elderly or youth

- Sepsis - Air embolism - Thrombosis - Pneumothorax - Cardiac tamponade

- Local: redness, tenderness, warmth, purulent drainage, swelling, change in vital signs - Systemic: fever, malaise, increased WBC

- Poor insertion technique - Multiple lumens - Bacteria adhering to fibrin sheath - Frequent dressing changes or poor technique - Long term use - Immunosuppression

- Notify physician of assessments - Obtain orders for blood cultures, hold any antibiotic orders until cultures done - Apply warmth to insertion site - Monitor VS - Keep dressings dry if discharge - Check facility policies (eg. sending tip of catheter to lab for C&S)

- Chest pain - SOB - Tachycardia - Decreased BP - Cyanosis - Dizziness

- Taking in air during insertion, tubing changes, or catheter removal - Catheter disconnected from extension tubing

- Emergency situation - Clamp line - Place in trendelenburg - Provide oxygen therapy - Notify physician - Monitor vital signs

- Swelling of arm and neck - Fever - Malaise - Neck pain radiating to arm or back - Tachycardia

- Poor positive pressure - Poor flushing technique or frequency - Non-thrombotic occlusion due to fibrin build-up and lack of turbulent flush

- Slow IV infusion rate - Apply warmth to site - Thrombolytic/anticoagulent agents may be used - Notify physician - Monitor vital signs