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 ID: 318983
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VASCULAR ACCESS DEVICES
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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 timeSlide3
TYPES OF VASCULAR ACCESSCentral Venous CathetersTunneled CVC’s:Hickman
Broviac
Groshong
Percutaneous CVC’s:
Ports
PICC Lines
FistulasSlide4
TUNNELED CATHETERS
Surgically inserted
Tunnel made through subcutaneous tissue (usually b/t clavicle and nipple)
Tip inserted through cephalic, internal or external jugular and threaded into superior vena cava
Held in place with Dacron cuff under skin
Placement verified through x-ray
Can be single, double or triple lumenSlide5
Tunneled catheters Placement of Tunneled Catheters Tunneled CathetersSlide6
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 tipSlide7
PORTSPlacement of ports Port ImagesSlide8
Reasons for PortsLong term IV therapyFrequent blood transfusions or blood drawsBone marrow transplantProtection of smaller vesselsSlide9
PortsAdvantagesDecreased chance of infection – port sealed under skinLess 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 maintainSlide10
PERCUTANEOUS CATHETERS -PICC LINES
PICC – Peripherally Inserted Central Catheter
Inserted in interventional radiology or patient room by:
Physician
Physician Assistant
Nurse Practitioner
Certified PICC nurse specialist
Placed in peripheral vein (basilic, cephalic or brachial) and advanced into superior vena cava or cavo-atrial junctionSlide11
PICC LINESHealthcare providers often use ultrasound for placement followed by x-ray (fluoroscopy)to assure proper placementSlide12
Reasons for PICC LinesReduced 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 pressureSlide13
FISTULAS
Used 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
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FISTULASFormation of fistulas Aneurysm of fistulaSlide15
FISTULASRadiocephalic
Brachiocephalic
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 veinSlide16
FISTULASBenefits:Lower infection ratesHigher 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 matureSlide17
DIALYSISTwo needles inserted into fistula, one to draw blood, one to return itSlide18
ReferencesBartholomay, 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