1. Central Venous Access Device
Photo: Community Nurses Lounge.comContent 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
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.
6.
7.
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
25. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• BEFORE PROCEDURE
1. Wash Hands
2. Assemble equipment
3. Don sterile gloves and other PPE
4. Use aseptic technique and observe standard
precautions throughout the procedure.
26. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• DURING PROCEDURE
1. Remove dressing from VAD insertion site.
2. Inspect Site and catheter
3. Disinfect the catheter-skin junction using
antiseptic solution
4. Dress access site
27. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• POST PROCEDURE
1. Discard used supplies
2. Remove gloves
3. Wash hands
4. Label new dressing
1. Document
28. 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)
30. 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.
31. CATHETER LOCKING
For intermittently used CVADs, (INS) 2008 recommends”locking”
with owconcentraion 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)
32.
33. 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.
Frequency of site assessment – every shift (depends on the organizational policies)Length of catheter- documented at the time of placement for future comparison
Using friction, apply antiseptic solution.-If using alcohol, apply friction for a minimum of 30 seconds-If chlorhexedinegluconate, use friction according to manufacturer’s labeled use and directionsOnly one application is necessaryPrepared site will be approximately the size of dressing i.e. 2 to 4 inches in diameterAllow antiseptic solution to air-dryRepeat twice as necessary depending on the solution
Documentation in the PMR should include:-site assessment-skin disinfectant-dressing material-patient response-and specific nursing actions taken to resolve
