Vascular Access Devices (Grade A)

Summary:

This passage discusses vascular access devices, which are used for repeated access to the vascular system to administer IV fluids and medications. There are two types of vascular access devices: peripheral IVs and central lines. Peripheral IVs are used for short-term fluid replacement and IV medications and can be found in veins in the lower arms and hands, while central lines are used for long-term IV therapy and have a catheter that empties into a central vein. Vein selection is important and depends on accessibility, mobility, and the patient’s condition, among other factors. Complications of vascular access devices include phlebitis, infiltration, extravasation, infection, and bleeding. Central lines have a higher risk of complications but are used when there is poor peripheral venous access or a need for frequent blood sampling or infusions of irritating/vesicant medications. There are several types of central venous access devices, including PICCs, non-tunnelled CVCs, tunnelled CVCs, and implanted infusion ports. Prevention of infection is important in managing these devices, as is maintaining patency and preventing damage.

Excerpt:

Vascular Access Devices

• Vascular access devices
  ○ Repeated access to the vascular system
  ○ IV fluids and meds
  ○ 1. Peripheral IVs
  ■ Short-term use
  ■ Tip of the catheter in the extremity
  ○ 2. Central lines/Central venous access devices (CVADs)
  ■ Long-term use
  ■ Tip of catheter empties into a central vein
• Peripheral intravenous catheters
  ○ < 3 inches (small, like a straw)
  ○ Inserted in peripheral veins in the lower arms and hands
  ○ Rotate sites q72 – 96 h depending on agency policy
  ○ Fluid replacement
  ○ IV meds (intermittent or continuous)
• Midline catheters (considered PERIPHERAL)
  ○ > 3 inches (measure from antecubital space to )
  ○ Inserted peripherally; extend to cephalic or brachial vein
  ○ Longer dwelling time (up to 6 weeks)
  ○ Do NOT confuse this with a peripherally inserted central catheter (PICC)
  ○ Midline caths are NOT central line
• Peripheral and midline catheters
  ○ Uses
  ■ IV fluids
  ■ Non-irritating IV meds
  ■ Blood/blood products
  ○ NOT recommended for
  ■ Chemotherapy
  ■ Vesicants: an agent capable of causing tissue destruction
  ■ Irritants: a drug with pH < 5 or > 9
  ■ TPN: total parenteral nutrition