Care of patient with CVC

Petra Sedlarova, Renata Vytejckova, Jana Hermanova

Central venous access

Access into blood stream via central vein

The distal end of the catheter ends in superior vena cava

Historical milestones

1929 – Werner Forssmann – the first to insert CVC (Nobel prize 1956)

1950 – Aubaniac – first cannulation of subclavian vein

1953 – invention of Seldinger technique (trocar, guidewire, sheath)

70s of 20th century – development central venous catheter associated with parenteral nutrition

The end of the 70s – clear guidelines on indication and contraindication of using CVC

Indications Serious condition with collapsed

peripheral veins Severe edema of extremities Long term treatment Long term parenteral nutrition Administration of high osmolarity

solutions Administration of vesicants CVP measurement Extracorporeal elimination methods

Contraindications

Serious coagulopathy Patient’s refusal

Types of catheters

Non-tunneled (short term) Swan – Ganz Catheter for hemodialysis

Tunneled (long term) Hickmann catheter Implantable venous port PICC

Swan - Ganz

Hickmann catheter

PICC

PORT

Insertion site: Superior vena cava

Subclavian vein Internal jugular vein External jugular vein Basilic vein Cubital median vein

Inferior vena cava Femoral vein

V. Jugularis interna

Material features

Hydrophilic Smooth surface should prevent thrombus

formation Anti infectious

Silver coated ATB coated

Silikon Vialon Polyurethan

Other classification Single lumen Multiple lumen

Catheter insertion

Puncture technique most common Sterile procedure - set up sterile field,

insertion kits are used Local anesthesia (1% trimekain, lidokain,

EMLA), occasionally general anesthesia Peripheral venous catheter Informed consent Monitoring

Seldinger technique

Check correct placement

By the length of the inserted catheter X ray Blood aspiration

Start treatment

Only after the placement has been verified by X ray

Possible complications

Pneumotorax

Bleeding into mediastinum

Puncture of a. subclavia

Hemotorax

Pulmonary embolism

Infection

Thrombosis

Damage of the vein wall

Patogenesis of infections

Intraluminal infection Extraluminal infection Endogenous infection

Factors contributing to infection

Health condition of the patient Skin condition at the insertion site Location of insertion site

Contributing factors - location

V. Femoralis Close to genitals Friction, movement

V. jugularis Movement Hair, facial hair, airway Possible kinking

Infection signs

Local – at the insertion site

General – fever, malaise

Suspect catheter infection - Draw blood cultures during fever

Preventive measures

Aseptic approach during insertion and care

Proper hand hygiene, gloves Minimize the number of lumens and

connections Minimize the length of insertion Use safe connectors (luer) Proper location of insertion site

Care of the catheter Always sterile approach Secure the catheter (stitches, sterile strips) Sterile dressing Regular dressing changes Regular changes of the tubings Minimize the number of connections Maintain the patency Needleless connections Clave, Q-syte, Posiflow

Dressing changes

Sterile equipment Gloves, face mask depending on the

type of the catheter Alcohol desinfection Dressing according to the guidelines

Transparent dressing Nontransparent dressing

Assessment of the insertion site

Taking blood samples

Syringe Vacuum system Procedure

Stop all infusions Discard first 10 to 20

ml of blood Draw the samples Flush with NSS

Possible complications

Removing catheter

Sterile procedure Compression of the insertion site Cut off the distal end of the catheter, send to

microbiology lab Monitor for bleeding