CVAD

1. Central Venous Access Device Photo: Community Nurses Lounge.com Content Revised as of November 26, 2013

2. What is CVAD? A central venous access device (CVAD) is a catheter that is inserted into the central venous system with the internal tip sitting within the superior/inferior vena cava or right atrium (Royal College of Nursing (RCN) 2010; Doughtery and Lister 2008). Photo: Tamara Joy Fowler

3. What is CVAD?

4. Why CVAD? Catheters can be used either short- or long-term for the infusion of: Parenteral Nutrition Chemotherapy or other vesicant or irritating solutions Blood and blood products Antibiotics Medication/solutions in patients with limited peripheral access Therapy that is ongoing or continued at home

5. CVAD at a Glance: Nurse’s POV

6. CVAD at a Glance: Patient’s POV

7. CVAD: Port at a Glance

8. Types of Central Venous Catheters Photo: Genentech Cath Matters USA

9. Types of Central Venous Catheters Photo: Genentech Cath Matters USA

10. Types of Central Venous Catheters Photo: Genentech Cath Matters USA

11. Types of Central Venous Catheters Photo: Genentech Cath Matters USA

12. Site Choices: Adult Patients

13. Site Choices: Pediatric Patients

14. Tunneled Catheters

15. Nontunneled Site

16. P.I.C.C. Line Photo: Genentech Sean Ternan

17. Implanted Port

18. Advantages and Disadvantages

19. Advantages and Disadvantages

20. Advantages and Disadvantages

21. Advantages and Disadvantages

22. Complications for CVAD

23. Complications for CVAD

24. Complications for CVAD

25. Care and Maintenance Assessment: - Insertion Site - Catheter Tract - Adjacent Skin

26. Care and Maintenance Site Care: - Skin Disinfectant - Clean, dry, and occlusive dressings

27. DRESSING Gauze or Transparent Semi-Permeable?

28. PROCEDURE FOR SITE CARE AND DRESSING CHANGE (Infusion Nurses Society: Norwood, Mass 2006) BEFORE PROCEDURE Wash Hands Assemble equipment Don sterile gloves and other PPE Use aseptic technique and observe standard precautions throughout the procedure.

29. PROCEDURE FOR SITE CARE AND DRESSING CHANGE (Infusion Nurses Society: Norwood, Mass 2006) DURING PROCEDURE Remove dressing from VAD insertion site. Inspect Site and catheter Disinfect the catheter-skin junction using antiseptic solution Dress access site

30. PROCEDURE FOR SITE CARE AND DRESSING CHANGE (Infusion Nurses Society: Norwood, Mass 2006) POST PROCEDURE Discard used supplies Remove gloves Wash hands Label new dressing Document

31. CATHETER FLUSHING Vascular Access Devices shall be flushed at established intervals to promote and maintain patency and prevent the mixing of incompatible medications and solutions . (Infusion Nursing Standards of Practice:INS , 2006)

32. How often?

33. CATHETER FLUSHING The flushing volume should at least be twice the internal volume of the CVAD and injection cap. Preservative-free 0.9% NaCl flushing solutions shuld be used to ensure and maintain patency of CVADs at established intervals. 0.9% NaCl with preservatives should not be administered to neonates and pediatric patients; if used with adult patients, the volume should not exceed more than 30mL per day Flushing with a heparin solution should occur to ensure and maintain patency of CVADs at established intervals.

34. CATHETER LOCKING For intermittently used CVADs , (INS) 2008 recommends”locking ” with ow concentraion heparin as follows: CVAD Heparin Lock Recommendations PICC and Nontunneled Daily with 5mL (10units/mL) Tunneled Twice Weekly with 5mL (10units/mL) Implanted Port Monthly with 3 to 5mL (100units/mL)

35. Heparin or Preservative-free 0.9 NaCl ? The move to use preservative-free 0.9%NaCl results from concern over heparin supporting microbial growth, periodic heparin supply Issues, And use of positive/neutral Pressure injection caps valves.

36. Trends in CVAD