Originally Created By: Sheila Elliott MN, RN Revised By: Tina Haayer, RN, BScN

 What is the definition of a CVAD?  What are the different types of CVADs?  Why are CVADs used?  How do you care for the different types of CVADs?  What are the complications associated with CVADs?

 A venous access device whose tip lies within the lower third of the vena cava (superior or inferior) or the right atrium. (Dougherty, 2006)

 PICC – Peripherally Inserted Central Catheter  Short-term, non-tunnelled CVAD - inserted directly into a central vein  Long tern, tunnelled CVAD – inserted under the skin  IVAD – Implanted Venous Access Device

 Inserted in antecubital region and threaded into central circulation  Very soft and flexible, easily damaged  Lower risk of infection  No BP’s or venipuncture on that arm  May be removed by RN once observed  Single or double lumen  May be an open or a closed system Tip Insertion

Open-ended Non-Groshong Open-ended Non-Groshong Closed-ended Groshong Closed-ended Groshong

 Inserted into jugular, femoral or subclavian vein

 Left in place until treatment complete, or complications occur  Located beneath the subcutaneous tissue  Appears as a palpable protrusion under the skin  Lower risk of infection  May only be accessed with a non-coring needle  Needles to be changed every 7 days, or every day if infusing TPN/blood products

 Reliable for patients requiring long term access (eg: chemotherapy, TPN)  Emergency access and for rapid infusion of fluids or blood products  To monitor central venous pressure  To provide venous access for patients who have poor peripheral venous access  Patient preference

ADVANTAGES DISADVANTAGES  Reliable long term access  Used for multiple blood samples  Used for blood products, meds, TPN & fluids  Removes need for constant venipuncture or peripheral punctures  Reliable long term access  Used for multiple blood samples  Used for blood products, meds, TPN & fluids  Removes need for constant venipuncture or peripheral punctures  ↑ risk of infection  ↑ risk of thrombus  Exposes patient to risk during insertion (pneumothorax)  Can affect body image  Can be traumatic to patient and may require general anesthetic for insertion  (Dougherty, 2006)

 Prevention of infection  Maintaining patency  Preventing damage

 Strict handwashing  Use sterile technique  Change dressings as recommended  Occlusive dressing over exit site  Keep system closed as much as possible  Change tubing, solutions and injection caps as recommended  Monitor for early signs of sepsis

 Patency is the ability to: ◦ Infuse through a catheter ◦ Aspirate blood from a catheter  Maintain patency with saline flushes: ◦ Prior to and after meds, TPN, etc. ◦ Before and after blood draws ◦ Refer to hospital policy  Methods of flushing include : ◦ Turbulent or pulsatile flush (creates turbulence and ↓ potential for debris to stick to inside or tip of catheter) ◦ Positive pressure (prevents backflow of blood into end of catheter)

 Proper securement of CVAD is vital in preventing the following complications: ◦ Catheter migration ◦ Phlebitis ◦ Damaged catheter

 L. Dougherty. (2006). Central Venous Access Devices: Care and management. Oxford, UK: Blackwell Publishing Ltd.