vascular access devices
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VASCULAR ACCESS DEVICES
VASCULAR ACCESS DEVICES
Introduced in early 1980s
Allow medications to be delivered directly into larger veins
Less likely to clot
Can be left in for longer periods of time
TYPES OF VASCULAR ACCESS
Central Venous Catheters› Tunneled CVC’s:
Hickman Broviac Groshong
› Percutaneous CVC’s: Ports PICC Lines
Fistulas
TUNNELED CATHETERSSurgically insertedTunnel made through subcutaneous tissue (usually b/t clavicle and nipple)Tip inserted through cephalic, internal or external jugular and threaded into superior vena cavaHeld in place with Dacron cuff under skinPlacement verified through x-rayCan be single, double or triple lumen
TUNNELED CATHETERS Placement of Tunneled Catheters Tunneled Catheters
PERCUTANEOUS CATHETERS -PORTS
•First used in oncology patients in 1981; now 100,000 ports implanted yearly•Surgically implanted beneath skin, usually in chest region•Right side of chest preferable d/t anatomy (superior vena cava) – “kangaroo” pocket created for portal body•Accessed by IP, Huber, or other type of needle with deflective, non-coring tip
PORTS Placement of ports Port Images
Reasons for Ports Long term IV therapy Frequent blood transfusions or blood
draws Bone marrow transplant Protection of smaller vessels
Ports Advantages
› Decreased chance of infection – port sealed under skin
› Less interference with ADLs – no external components
› Less body image concerns (teens)
› Long usable life – up to 10 years (compared to <1 yr for PICC line)
Disadvantages› Needle access › Most expensive device
to place› Requires minor surgical
procedure for placement
› Can be difficult for patients to maintain
PERCUTANEOUS CATHETERS -PICC LINES
PICC – Peripherally Inserted Central Catheter
Inserted in interventional radiology or patient room by:
PhysicianPhysician AssistantNurse PractitionerCertified PICC nurse specialist
Placed in peripheral vein (basilic, cephalic or brachial) and advanced into superior vena cava or cavo-atrial junction
PICC LINES Healthcare providers often use ultrasound for placement followed by x-ray (fluoroscopy)to assure proper placement
Reasons for PICC Lines Reduced number of needle punctures Prolonged IV antibiotic treatment TPN nutrition Chemotherapy Repeated administration of blood or
blood products Venous blood samples Measurement of central venous
pressure
FISTULASUsed for dialysis in patients with renal impairment
Surgeon joins an artery and vein, bypassing capillaries, allowing blood to flow rapidly through the fistula
Created in the non-dominant arm
If vein quality is poor, grafts can be used
Takes approximately 4-6 weeks to mature
FISTULAS Formation of fistulas Aneurysm of fistula
FISTULAS
RadiocephalicBrachiocephalic
Most common fistula for hemodialysis Created in forearm near wrist Radial artery anastomosed to cephalic
vein
Often created if poor lower arm vessels or after failure of radiocephalic fistula
Created in arm near elbow Brachial artery anastomosed to cephalic
vein
FISTULAS Benefits:
› Lower infection rates
› Higher blood flow rates = more effective dialysis
› Lower incidence of thrombosis
Complications:› “Steal syndrome”
= cold limb, cramping, tissue damage
› Aneurysm d/t repeated needle insertion
› Thrombosis› Failure to mature
DIALYSIS
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Two needles inserted into fistula, one to draw blood, one to return it
References
Bartholomay, M., Dreher, D., Evans, T., Finn, S., Guthrie, D., Lyons, H., Mulligan, J., & Tyksienski, C. (n.d.) Nursing management of venous access devices: Non-tunneled catheters. Retrieved from http://www.mghpcs.org/EED_Portal/Documents/Central_Lines/CL_Module7.pdf
Nursing Link (2012). The use and maintenance of implanted port vascular access devices. Retrieved from http://nursinglink.monster.com/training/articles/302-the-use-and-maintenance-of-implanted-port-vascular-access-devices
Queensland Vascular (n.d.) Vascular and endovascular surgery. Retrieved from http://www.qldvascular.com.au/renal-clinic.html
Roe, E. J., III, & Turner-Lawrence, D. (2012). Central venous access via subclavian approach to the subclavian vein. Retrieved from http://emedicine.medscape.com/article/80336-overview
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