Venous access devices in clinical practice
Download
1 / 36

Venous Access Devices in Clinical Practice - PowerPoint PPT Presentation


  • 186 Views
  • Uploaded on

Venous Access Devices in Clinical Practice. An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies. Useful to Know. Venous Access is essential . Establishing and maintaining reliable access is a priority.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Venous Access Devices in Clinical Practice' - ray-ramsey


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Venous access devices in clinical practice

Venous Access Devices in Clinical Practice

An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies


Useful to know
Useful to Know

  • Venous Access is essential .

  • Establishing and maintaining reliable access is a priority.

  • EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital.

  • The choice of which VAD to use is a collaborative process.


Access is essential
Access is essential

  • Infusion therapies play a major role in the treatment plan for almost every disease process.

  • Need for IV therapy is one of the criteria for provider approval of hospital admission.


2 types of devices
2 types of devices

  • PIV’s

    short catheters (less than 3 inches) placed in the veins of the upper extremities.

  • CVAD’s

    long catheters whose terminal tip position is in the central veins.


Venous access devices

Peripheral

Most appropriate device for short term therapies (less than 5 days) that are nonirritating.

Central

When ordered meds have pH greater than 9.0 or less than 5.0, osmolality greater than 500 mOsm.

Ordered meds/fluids are known irritants

PN with dextrose con-centration greater than 10%.

IV inotropes

Vesicants

Venous Access Devices


Peripheral iv s
Peripheral IV’s

Placed by the nursing staff on the units 24/7 with the assistance of the IV Team for those patient’s that are difficult sticks.

IV Team is in house 7 days a week from 8AM-7:30PM.

Pager #3471988


Cvad s
CVAD’s

Are placed by multiple physician and non-physician providers throughout the hospital based on the type of device that is required.


3 types of cvad s
3 Types of CVAD’s

  • Non-tunneled

  • Tunneled

  • Implanted


Nontunneled
Nontunneled

  • Inserted by percutaneous stick into the internal jugular, subclavian, femoral or upper arm veins.


Tunneled
Tunneled

  • The catheter is tunneled under the skin to a vein in the neck or chest. A cuff near the exit site anchors the catheter in place.


Implanted
Implanted

Surgically inserted under the skin in the upper chest or the arm and appears as a bump under the skin.


Which vad
Which VAD?

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.


Appropriate vad selection
Appropriate VAD Selection

  • Minimizes patient discomfort, morbidity and mortality

  • Decreases health care costs associated with delays of therapy and increased LOS.

  • Enhances therapeutic benefits for patients with minimal impact on ADL’s.



A good beginning makes a good end

"A good beginning makes a good end."

Louis L’amour


Planning is essential
Planning is essential

Starts with the first IV order

Discuss on rounds…..with the patient.


What type of access device is the most appropriate for the patient
What type of access device is the most appropriate for the patient?

  • Duration of therapy

  • Characteristics of the infusates

  • Available insertion sites

  • Existing co-morbidities

  • Impact on ADL’s


Duration of therapy
Duration of Therapy patient?

  • < 5-7 days – peripheral IV

  • >7 days<2 weeks (in house patients) temporary CVAD

  • 1-6 weeks – PICC

  • >6 weeks – Tunneled or Implanted


Type of infusates
Type of infusates patient?

  • pH < 5

  • pH > 9

  • Osmolality > 600

  • Caustic or vesicant medications


Available insertion sites
Available insertion sites patient?

Consider CVAD placement when:

  • Peripheral IV access cannot be initiated or maintained in the upper extremities.

    IV’s ‘blow’ or last only a few hours.

    No lower extremity IV’s.

  • The patient has a history of being a “difficult stick” and has required central access in the past.



Infiltration
Infiltration patient?


Extravasation
Extravasation patient?


Picc thrombosis
PICC Thrombosis patient?


Co morbidities and device selection
Co-morbidities and Device Selection patient?

  • Certain types of CVAD’s may be contraindicated based on pre-existing conditions.

  • Chronic Kidney Disease, Hypercoaguable syndromes, preexisting venous stenosis, thrombosis, etc.


Impact on adl s
Impact on ADL’s patient?

  • Availability of care giver assistance.

  • Dressing requirements and catheter stability.

  • Use of mobility aids.

  • Work and home activity limitations.


When how and by whom will the device be placed
When, how and by whom will the device be placed? patient?

PIV’s

Unit staff and IV Team

CVAD’s

Nontunneled – resident staff, PICC nurses, interventional radiology, anesthesia

Tunneled – Interventional radiology, peds surgery

Implanted – Interventional radiology


When to order
When to Order? patient?

  • Based on patient need and ordered therapies

  • Early decision making and placement of an appropriate device is correlated with positive clinical outcomes and decreased length of stay.

  • Remember: PICC, tunneled and implanted device placement requires lead time of 1-3 days. Do not wait until day of discharge to order lines for home infusion.


Which device to order
Which device to order? patient?

Temporary Nontunneled:

Best for short term facility based access (less than 14 days)

Long term Nontunneled:

Typically used for 1-6 weeks of therapy. (PICC’s) May be used in the home setting.


Which device to order1
Which device to order? patient?

  • Tunneled catheters:

    More permanent device best used for dwell times > than 4-6 weeks or when a PICC is contraindicated.

  • Ports:

    Most beneficial when long term intermittent therapies are needed.


How to order cvad s
How to order CVAD’s patient?

  • For PICC’s:

    Search ‘PICC’ in CPOE

    Select “PICC Procedure (Adult and Ped) from the order menu.


How to order
How to order patient?

  • Tunneled or Implanted devices:

  • Search ‘CVAD’:

    ‘CVAD-insert tunneled w/o port >5 years’

    ‘CVAD-insert tunneled with port >5 years.


Vad placement decisions
VAD Placement Decisions patient?

An integral part of the treatment plan

Collaborative in nature

Coordinated effort of multiple providers


Resources
Resources patient?

  • Patient

  • Consult services (nephrology, infectious disease)

  • PICC RN: 2168219

  • VIR: consult pager 2168477

  • Home Infusion Nurse: 3471934

  • CCM and Social Workers


Useful to know1
Useful to Know patient?

  • Venous Access is essential .

  • Establishing and maintaining reliable access is a priority.

  • EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital.

  • The choice of which VAD to use is a collaborative process.


ad