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Premium member Presentation Transcript MANAGEMENT OF INVASIVE LINESBARBARA RAVIDA RNC, MSNADJUNCT LECTURERFALL 2008 : MANAGEMENT OF INVASIVE LINESBARBARA RAVIDA RNC, MSNADJUNCT LECTURERFALL 2008 First developed in the 1960’s to provide intravenous nutrition.Now utilized for both ambulatory and in-hospital patients.Placed by physicians, physician assistants, specially trained Nurse Practitioners or nurses. : First developed in the 1960’s to provide intravenous nutrition.Now utilized for both ambulatory and in-hospital patients.Placed by physicians, physician assistants, specially trained Nurse Practitioners or nurses. Central Venous Vascular Access Devices (CVAD’s) provide a route for: : Central Venous Vascular Access Devices (CVAD’s) provide a route for: Medication Fluid Nutrition Obtaining blood samples Types: : Types: Non-tunneled CVAD’s Tunneled CVAD’s PICC’s (Peripherally Inserted Central Catheters) Implanted ports Non-tunneled CVAD’s-- : Non-tunneled CVAD’s-- Utilized for fast access Placed into the subclavian vein 6-8 inches long 1-4 lumens Silicone or polyurethane Can handle any type of fluid/blood products No set standard for how long they can remain in place. Most hospitals, 5-7 days For in-hospital use only Requires a dressing Highest infection rate Tunneled CVAD’s-- : Tunneled CVAD’s-- Long term use Hickman, Broviac, Groshong, Hohn & Leonard are some common brands Placed into the subclavian vein via a subcutaneous tunnel on the chest wall 8-10 inches long 1-2 lumens Silicone Can handle all fluids Has a cuff that scar tissue grows around to anchor in place Dressing only for 14 days then open to air PICC’s-- : PICC’s-- Long term use Placed into superior vena cava via a peripheral vein 20-25 inches long 1-2 ports Silicone Requires a dressing Can handle all fluids Very delicate, can break, can occlude Very low infection rate Implanted Ports-- : Implanted Ports-- Long term use (up to 2000 punctures) Under the skin Handles all fluids but best for intermittent infusions, ie. Chemotherapy Metal or plastic port with center self-sealing silicone gel and silicone tubing Minimal infection rate Convenient; cosmetically appealing Drawback—requires surgical procedure and painful needle placement for each treatment Placement & Follow-up: : Placement & Follow-up: Sterile procedure by trained professional Always confirm placement by chest x-ray before use: the tip should rest in the superior vena cava (except for a femoral line where it rests in the inferior vena cava) ***If the tip rests in the right atrium it could trigger arrhythmias as it floats across the SA node; it could also become tangled in the tricuspid valve causing damage that would require surgery to replace the valve PICC lines are documented by length and any suspected changes should be reported Care of CVAD’s: : Care of CVAD’s: Sterile dressing change as per hospital or outpatient nursing service Flush with either heparin or saline; dependent on device & policy Do not use a central line that does not provide blood back unless confirmed by x-ray Do not use alcohol or acetone to cleanse the catheter as it may cause breakdown Site exposure should be kept to a minimum Other types/functions of invasive lines: : Other types/functions of invasive lines: Arterial– inserted in an artery (radial, femoral or brachial) to monitor arterial blood pressure and to obtain blood gas monitoring Dialysis catheters for hemodialysis Monitor central venous pressure Monitor hemodynamic status FLUSHING CVAD’S-- : FLUSHING CVAD’S-- Central lines are flushed to maintain patency for use. Most central devices are flushed using the SASH method using saline (5-10ml)/heparin 300-500 units/ administer medication/saline 5-10ml. Amount of heparin can depend upon hospital policy and patient condition AIR EMBOLISM-- : AIR EMBOLISM-- One of the most serious complications of CVAD’s Intrathoracic pressure becomes lower than atmospheric pressure and air enters the bloodstream potentially traveling to the heart Symptoms include cyanosis, hypotension, respiratory distress, cardiac arrhythmia Prompt treatment of air embolism includes positioning the patient in the left lateral Trendelenburg position which moves the air bubble away from the pulmonic valve where it could be blocking blood from entering the right atrium When removing a CVAD the patient should be supine and asked to hold their breath and bear down during removal so as to increase intrathoracic pressure and reduce the likelihood of air embolism You do not have the permission to view this presentation. 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