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Central Venous Access Devices Made Incredibly Easy Adapted from a 2005 project
What You Will Learn Today ,[object Object],[object Object],[object Object],[object Object],[object Object]
Unit RN Responsibilities: CVADs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of Catheters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Catheter can be for dialysis
To ID the CVAD, Assess the Following: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1. Implanted Port vs. External  Photo: C. Lewis Photo: Unknown
Implanted CVCs (Port-A-Cath) Insertion performed in O.R. or Radiology Suite
2. External: Tunneled vs. Non Tunneled Photo: Unknown
Peripherally Inserted Central Catheter (PICC) Photo: C. Lewis
3. Open-End or Groshong Valve ,[object Object],[object Object],[object Object]
Groshong Valve ,[object Object],[object Object],[object Object],[object Object]
4. How Many Lumens?
5. Is the Catheter Designed for Dialysis or Apheresis? Photo: C. Lewis Photo: C. Lewis Patients receive ID card at time of insertion.
6.  Where Does the Catheter Enter the Venous System? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
7.  Where Does the Tip Terminate?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessing for Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Possible CVAD  Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to Draw Blood from Central Line for Culture ,[object Object],[object Object],[object Object],[object Object]
Damaged Catheter ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ways to Prevent Damage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Occlusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Graphics showing different kinds of occlusions follow
Lipid Accumulation
Intraluminal Clot Formation ,[object Object],[object Object],[object Object],[object Object]
Fibrin Sheath ,[object Object]
Fibrin Sheath ,[object Object]
Mural Thrombus ,[object Object]
Fibrin Tail ,[object Object],[object Object],[object Object],[object Object]
Fibrin-Tail ,[object Object],[object Object],[object Object],Occluded Photo: C. Lewis
Fibrin Occlusion May be Amenable to Thrombolytic Therapy ,[object Object],[object Object],[object Object],[object Object]
Catheter Embolism ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Findings: Embolism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management: Embolism ,[object Object],[object Object],[object Object]
Can Infuse But Not Aspirate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Can Aspirate But Not Infuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pinch-off Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pinch-off Syndrome Source: Unknown
Tunneled CVADs ,[object Object],[object Object],[object Object],[object Object]
Line Care
Implanted Ports ,[object Object],[object Object],Photo: C. Lewis
Accessed Port-A-Caths ,[object Object]
Dialysis/Apheresis Catheters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Managing Multiple Ports ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lab Draws from Central Lines ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lab Draws from Central Lines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
After All Blood Draws or Blood Infusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Document All Flushes ,[object Object],[object Object],[object Object],[object Object]
Syringe Size and Flush Pressure ,[object Object],[object Object],Source: Unknown
Flush Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Class Exercise ,[object Object],[object Object],[object Object],[object Object]
Percutaneously Inserted  Central  Catheter (PICC) 1
Percutaneously Inserted  Central Catheter (PICC) ,[object Object],[object Object],1
Implanted Vascular Access Device (Port-A-Cath) 2
Implanted Vascular Access Device (Port-A-Cath) ,[object Object],[object Object],2
Subclavian Hickman Catheter 3
Subclavian Hickman Catheter ,[object Object],[object Object],3
Tunneled Dialysis  Catheter 4
Tunneled Dialysis Catheter ,[object Object],[object Object],4
Tunneled Catheter 5
Tunneled Catheter ,[object Object],[object Object],5
Summary ,[object Object],[object Object]
To ID the CVAD, Assess the Following: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],END

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Central Venous Access Devices Made Incredibly Easy!

Notas del editor

  1. Advanced
  2. Super users group
  3. If you can answer all of these questions, you can figure out how to assess and care for this catheter.
  4. From http://www.aegis.com/pubs/step/1992/STEP4301.html Central Catheters, Implanted Ports Implanted ports have all of the advantages of a central line except they are not always immediately available for use. A port is a small titanium reservoir with a rubber "stopper" that is attached to the catheter entering your vein below the collarbone. The whole thing is implanted under the skin in an outpatient procedure with local anesthesia and IV sedation. These catheters are usually not noticeable under your skin, but may sometimes show as a small lump. In order to use this catheter, the nurse must locate and clean the site, and place a special needle through the skin and into the rubber stopper. This can be done for each dose of medication or left in place with a plastic dressing and weekly changes. Ports that remain in place between usages are usually bulkier and more cumbersome to "wear" than a tunnelled catheter, and the dressing needs to be kept clean and dry. The ports are made to withstand 2000 needle entries, but this does irritate the skin over the port. Most people develop a callus that quits hurting when the needle is placed through the skin. As a patient, you can be taught to clean the site and access the port with a needle, but it is difficult to learn and complicated to do. Because of the procedures involved in accessing the port for use, these catheters are usually not recommended for daily or more frequent medications. They are perfect for someone who gets a medication only once a week or for a week every six weeks or some other intermittent schedule. One type of implanted port is actually placed in the arm near the elbow and the catheter line threaded up the vein to the Superior Vena Cava, but they offer no particular advantage over a chest port, tend to have more complications, and are harder for the patient to self-access since two hands are almost required for the procedure. When the port is not accessed, it is hardly visible and requires no care other than a once monthly access for flushing with heparin. Patients with unaccessed ports can swim, though sometimes a doctor will recommend covering the site with a waterproof plastic dressing. Since the skin is an excellent barrier to bacteria, unaccessed ports rarely become infected. However, frequent accessing of a port, or leaving the access in place for extended periods can make the odds of infection greater than with with a tunnelled-type catheter. Blood can be drawn from a port for lab tests, if your doctor consents.
  5. Super users
  6. From: Nursing 92, June, p. 27 From Nursing 92, June, p. 27
  7. Illustration adapted from Bagnall-Reeb, H. (1998). Journal of Infusion Nursing 21(5S):S115-S121.
  8. Illustration adapted from Bagnall-Reeb, H. (1998). Journal of Infusion Nursing 21(5S):S115-S121.
  9. Super users
  10. If you can answer all of these questions, you can figure out how to assess and care for this catheter.