CVADs

Question 1

What are CVADs

Answer 1

• Catheters introduced into the superior vena cava via a large vein
• The catheter tip terminates in the distal superior vena cava

Question 2

UseI

Answer 2

Can be used to administer:
- Hypertonic solutions, such as total parenteral nutrition (TPN)
- Vesicants such as chemotherapy treatments
- Irritants such as cloxacillin
- Solutions with extreme pH values such as vancomycin

Question 3

Types

Answer 3

1. Centrally inserted
2. Peripherally inserted
3. Tunnelled
4. Implantable vascular access device

Question 4

What is the choice of the CVAD based on?

Answer 4

• A patients diagnosis
• Length and type of therapy
• Patient preference
• Clinical status
• Availability and quality of patient veins
• Operator experience
• Previous CVAD history

Question 5

Structure

Answer 5

1. Lumens
2. Clamps and valves
3. Coating

Question 6

What are lumens for

Answer 6

• Can infuse incompatible medications simultaneously via separate lumens
• Solutions do not mix as they travel through the CVADs different lumens. Each lumen opens separately from the other lumens at the distal end of along various areas of the catheter

Question 7

Coating

Answer 7

1. Antimicrobial or antiseptic: reduces the risk of infection
2. Heparin: reduces fibrin formation
3. Radiopaque: makes tip easily visible on x-ray

Question 8

Central line associated bacteraemia (CLAB)

Answer 8

• Blood stream infection caused by bacteria and microorganisms that colonise a CVAD
• Can occur during the CVAD insertion procedure or post-insertion care resulting in serious illness
• Majority of CLABs are preventable

Question 9

Air embolism

Answer 9

Occurs when air embolus enters the bloodstream and travels to the lungs, heart or brain, inducing brain damage or death

Question 10

How do air embolisms occurs?

Answer 10

• Active injection of air into the bloodstream
• Passive movement of air into the bloodstream when the venous pressure is less than the prevailing atmospheric pressure
• Changes in the intrathoracic pressure can result in air embolism if there is a break in the system above the level of the heart. Changes in the intrathoracic pressure are caused by actions such as coughing or sneezing

Question 11

Occlusion

Answer 11

• range of thrombotic and non-thrombotic causes
• May be partial or total and may prevent CVAD from functioning properly

Question 12

Signs of an occluded CVAD catheter

Answer 12

• Little or no free-flowing blood return
• Inability to withdraw fluids
• Inability to infuse fluids
• Increased resistance during flushing
• Sluggish fluid flow through catheter

Question 13

Catheter migration assessment

Answer 13

Signs and symptoms of catheter migration include:
- Inability to flush, infuse or aspirate
- Leaking of IV solutions/flushes at insertion site
- Change in trace if catheter has migrated into the right atrium
- Gurgling in the ear during flushing – may indicate that the tip has migrated to the internal jugular
- Headache, pain, swelling, redness, should, arm or neck discomfort
- Coldness felt in the middle of the back on flushing
- Tunnelled catheters – coiling of catheter in tunnel, able to palpate coil in tunnel
- Changes in the external catheter length

Question 14

Changing dressing

Answer 14

You should change the dressing every 7 days or sooner if:
- The dressing is not intact
- There is evidence of inflammation and/or discharge from the exit site
- There is excessive accumulation of blood or moisture