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.
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An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies
short catheters (less than 3 inches) placed in the veins of the upper extremities.
long catheters whose terminal tip position is in the central veins.
Most appropriate device for short term therapies (less than 5 days) that are nonirritating.
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%.
VesicantsVenous Access Devices
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.
Are placed by multiple physician and non-physician providers throughout the hospital based on the type of device that is required.
Surgically inserted under the skin in the upper chest or the arm and appears as a bump under the skin.
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.
Starts with the first IV order
Discuss on rounds…..with the patient.
Consider CVAD placement when:
IV’s ‘blow’ or last only a few hours.
No lower extremity IV’s.
Unit staff and IV Team
Nontunneled – resident staff, PICC nurses, interventional radiology, anesthesia
Tunneled – Interventional radiology, peds surgery
Implanted – Interventional radiology
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.
More permanent device best used for dwell times > than 4-6 weeks or when a PICC is contraindicated.
Most beneficial when long term intermittent therapies are needed.
Search ‘PICC’ in CPOE
Select “PICC Procedure (Adult and Ped) from the order menu.
‘CVAD-insert tunneled w/o port >5 years’
‘CVAD-insert tunneled with port >5 years.
An integral part of the treatment plan
Collaborative in nature
Coordinated effort of multiple providers