1. Hannon Oncology Education 2014 Introduction To CVAD’s

2. Learning outcomes Types of lines/ Choosing a device Advantages Challenges Practical session Q&A 2

3. Perm/Vas Caths Portacath Hickman PICCs Central lines Types of CVAD’s

4. Common factors Tip of each line sits in middle/lower third of superior vena cava All require aseptic non-touch technique (ANTT) Advantages/disadvantages to each Patient choice important PICCs most common All require flushing to prevent blocking of line Infection and line occlusion most common problem 4

5. Choosing a line Type of therapy Duration of therapy Device factors Patient factors Insertion teams availability Unit preference 5

6. Used for dialysis and plasma pheresis only Restricted to specialist users only Not for use by community staff Perm/Vas caths

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8. Implantable device Long term use i.e. > than 6 months at least Allows Independence Patients can use themselves Infections can be serious Portacath

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10. Single/double/triple lumens Long term use Patients can use themselves Infections can be serious Hickman

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12. Peripherally inserted central catheter Single/ double lumen Short/medium term use Require weekly dressings More difficult for patient to use independently Easily inserted/removed Infections can be serious PICC’s

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14. Double/triple lumen Short term use only, changed after 5-7 days Ideal for post-op patients Hospital use only Central line

15. Short term central lines 15

16. Advantages of CVAD’s Direct access to the venous system Once inserted less discomfort/venipunctures for patient Increases independence for patients on long term therapies Multi-purpose e.g. fluids, blood, antibiotics, chemotherapy, monitoring, phlebotomy, nutritional support….. 16

17. Challenges Risk of infection Staff training and competency Thrombosis/thrombophlebitis Catheter occlusion Persistent withdrawal occlusion Catheter fracture 17

18. Contd… Insertion complications/air embolus/arterial puncture/nerve irritation Line migration Cardiac arrhythmia due to malposition Traumatic insertion due to vessel stenosis/patient anxiety/anatomical anomalies/dehydration….. 18

19. Introducing a CVAD phlebotomy service Staff training programmes, theory content and assessors Multidisciplinary team input e.g. lab/medical/nursing /portering staff Resources 19

20. Q&A ? 20 Discussion References available upon request Thank you!