Content Revised as of November 26, 2013 Photo: Community Nurses Lounge.

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Conference participants will understand that:
• There are different types of venous access
• Ensuring adherence to policy and procedure is essential for
safety of the patient
• There are multiple complications associated with CVADS
• Knowledge of the care for the different types of CVAD is
required prior to utilizing the lines
DEFINITION
• An implanted or indwelling bio-compatible device placed in the
SVC / IVC, used for the administration of therapeutic substance /
agents into the central venous system.
• Blood flow rate approximately 2 ltrs/min
Tip is placed in the
Superior Vena Cava,
approximately three
centimeters proximal to
the junction of SVC and
Right Atrium
• Appropriate location for vesicant therapy, TPN, long-term IV therapy,
solutions/medications with a pH < 5 or > 9 and or serum osmolality > 500 mOsm/L
• Largest vein, Good blood flow and are relative immobile areas
 CVAD’s

Non-tunneled Tunneled Implanted

Temporary triple Powerline,
lumen, Mediport,
Hickman,
PICC’s Broviac Portacath
 Arrow, Cook ( 7 - 10 Days )
Cavafix
Short Term
Hohns ( 1 - 2 Months )

Intermediate Term
Hickman
( 1 Year or
PICC
LONG TERM more )
Ports
Photo: Genentech Cath Matters USA
Open ended only
1-3 lumens
Photo: Genentech Cath Matters USA
Photo: Genentech Sean Ternan
Photo: Genentech Cath Matters USA
 Short term central catheter

Peripherally Inserted Central Catheter – Open or closed ended, 1-2 lumens

456 CVAD LINES INSERTED PICC lines 2014

IN 2014
140

120

100
• 7% FOR TPN
80

• 39% EMERGENCY CARE 60

& ANTIBIOTICS 40

• 36% CHEMOTHERAPY
20

0
• 18 % DIALYSIS & OTHER TPN Abx Chemo Other
Photo: Genentech Cath Matters USA
 The goal is to choose a
device with the lowest
risk of complications
(infectious and
noninfectious) which will
last the duration of
therapy or be managed
with minimal
replacements.
Decrease health care cost, enhances therapeutic benefits & ADL’s
• Recurrent therapies
• Infusion of Vesicant / Irritant drugs (vanco, dopa)
• Long term Infusion / Hyperosmolar
solutions ( TPN )
• Immunocompromised /prone to go: Septicemic
• Poor vein status ( Obese / Pediatric)
Whenever possible, PLACE THEM EARLY
 Early patient assessment is vital !!

 Purpose and type of infusion

 Consider patient history and activity
 Project length of therapy
 Predisposing medical conditions
 OPEN-ENDED VALVED
• BROVIAC - PEDIATRIC • GROSHONG - PEDIATRIC
-2.7 FR. / 4.2 FR. / 6.6 FR. - 3 FR.
( SINGLE LUMEN ) - 5 FR.
• HICKMAN -( ADULT ) • GROSHONG- ( ADULT )
-9.6 FR. S/L -7 FR.
-9 FR. D/L
-8 FR.S/L
-10 FR. T/L
-9 FR. D/L
-12.5FR.T/L
• POWERPORTS
• Silicon construction
• Dacron cuff
•
• Vita cuff (option)
• Molded bifurcation
• Radio-opaque
• Color coded
adaptors
• “ Clamp here”
reinforced sleeve
• Lumen size printed
on sleeve
(AKA PORTACATHS, PORTS, MEDIPORTS AND PASSPORTS)
Port implanted in SubQ tissue
• Venous, arterial and Peritoneal port
• Adult and pediatric sizes
• Titanium, silicone coated, MRI
• Attachable / preconnected with open-ended Hickman
catheters
• Attachable with Groshong catheter
• High profile and low profile port
• Silicone construction
• Smaller Outer Diameter, larger Inner
Diameter.
• Thinner wall
• Radio-opaque tip
• No clamping required
• Weekly saline flush
 5 Fr
7 Ff
8 Fr

9.5 Fr D/L
• Decreased pain of repeated venipuncture

• Easier & quick access for blood withdrawal & emergency

treatment

• No ecchymosis of skin post-needle-stick

• No restriction of ambulating / normal activities

• Decreases the emotional stress of receiving CT

•Requires special care /
maintenance.
•Requires experienced personnel
for insertion.
 PICC- by Trained Nurses / Doctors
 Bed Side procedure /Fluoroscpy

 No Anesthesia / waiting period

 No vein wastage

 No arm movement restrictions

 Less complications / cost effective

TUNNELED CATHETERS / PORTS – DOCTORS

• OT REQUIRED
• GA FITNESS
• HEMATOLOGICAL PARAMETERS
 Tunneled catheters / PICC / Ports

 Hand washing

 Site Cleaning / dressing

 Patency / Flushing
(24 hrs. post insertion. Thereafter, weekly and PRN for
transparent dressings and 3x/week for gauze dressings. Strict
adherence to sterile technique is required).
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The flushing volume should at least be twice the internal volume of the
CVAD and injection cap.
Preservative-free 0.9% NaCl flushing solutions should be used to
ensure and maintain patency of CVADS at established intervals.
It should not be administered (BENZYL) 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. (10 UNITS/ML).
For intermittently used CVADS, CDC recommends “locking” with low
concentration heparin as follows:

CVAD Heparin Lock Recommendations

PICC and Non-tunneled Daily with 5mL (10units/mL)

Tunneled Twice Weekly with 5mL

(10units/mL)
Implanted Port Monthly with 3 to 5mL (100
units/mL)
The move to use preservative-free 0.9% NaCl results from concern
over heparin supporting microbial growth and alteration in blood
parameters. Use of positive/neutral pressure injection caps valves.
• –The cap and extension
tubing are changed with each dressing change weekly and
after every blood draw.

45
• Good hand hygiene
• Ensure to “scrub the hub” with
chlorehexidine for minimum
30sec prior to accessing devices
• Wear sterile gloves and mask
(patient should wear mask as
well) anytime opening dressing.
• Removal of unnecessary CVC
should be regularly assessed.
  Non-Infectious
 Block / Occlusion/ Fibrin sheath(prevention – flush): Cathflow
Activase Instillation (2 mg. /lumen)

 Catheter fracture / rupture (10cc –larger syringe, small syringes

generate high pressure)
 Mal-position/ Migration: (Xray)
 Phlebitis/Infiltration (discontinue, care)
 Accidental Expulsion
Embolism (emergency – resuscitation)
 Infectious
 Site infection
 Lumen Infection
 Septicemia
 Septic thrombophlebitis
 Phlebitis and/or cellulitis
• Get informed and written consent (risks and benefits outlined).
• Inform patient of all VAD options
•Documentation – concise and accurate
•Know tip placement of each CVAD before using it
•Follow hospital policies

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 CONGRATULATIONS !
THANK YOU FOR YOUR PARTICIPATION

• IT HAS BEEN MY PLEASURE TO BE WITH YOU HERE TODAY.

• THE GREATEST GIFT IN LEARNING SOMETHING NEW IS PUTTING THAT
KNOWLEDGE INTO PRACTICE AND THEN SHARING WHAT YOU KNOW
WITH SOMEONE ELSE.
• DO USE YOUR NEW FOUND OR RENEWED KNOWLEDGE AND
PRACTICE! PRACTICE! PRACTICE!
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• YOU ARE ALL WINNERS!