IV Therapy

Skills
Related to
Central
Access
Devices
1
Introduction and Overview

CVC PORT
Long-Term Long-Term

PICC MIDLINE
2 - 4 Weeks
Up to 1 year

PERIPHERAL
< 1 Week
2
 Nurse Practice Acts
 RN
 LPN
 Standards of Practice
 Centers for Disease Control
 Institutional Policies
 Role of the IV Team/ Interventional
Radiology
3
Indications for Use
 Diagnosis–related
 GI dysfunction
 Cancer
 Medical interventions
 Medications
 TPN
 Other
 Patient request
 Long term therapies

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Contraindications

 Scaring
 Allergies
 Medication
 Disease related
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Catheter Types

 Non-tunneled
 PICC
 Tunneled
 Implanted
 Dialysis

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7
 Choosing a Device


Consent
Body image
 
                                                               

 Medical considerations
 Drug properties

8
 Catheter Considerations

 Physical properties
 Open versus closed catheter
 Single versus multi-lumen
 Ease of care

9
Anatomical Placement

 Left versus Right

Subclavian/superior
vena cava
placement
 Jugular/inferior vena
cava placement
 Atrial placement
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Client Preparation

Informed Consent forms

Consent
Purpose for
treatment
Education

Bedside vs. operative placement

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 Equipment Preparation

 Use of Electronic Infusion Device

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Non-Tunneled Catheters

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Indications and Use

 Emergency Use
 Short term use
 MD preference

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Site Selection

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 Selection and Preparation
of Equipment

 Catheter
insertion kit
 Caps
 Flushes
 Infusion
Device
 Post-insertion
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Client Preparation

 Education
 Positioning
 Assisting the
physician with
insertion
 Assessment

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 Nursing Care

 Tip placement
 Maintaining patency

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 Nursing Care

 Dressing changes
Client teaching
12/01 Dr. Smith
 R 12/24 dd

 Complications
 Discontinuing

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Peripherally Inserted Central
Catheters (PICC)

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Indications and Use
 Economics
 Short term
 Mid-clavicular vs. centrally placed
catheters

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Site Selection

 Basilic
 Cephalic
 Median Cubital

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Client Preparation
 Education
 Choice

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Insertion
 Video presentation of sample insertion

                                                             

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Nursing Care

 Placement verification

                              
 Maintaining patency
 Dressing changes
 Repairs
 Discontinuance

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Tunneled

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Indications and Use
 Long term use with IR/OR placement
 Anti-microbial cuff vs. Dacron Cuff
 Broviac, Hickman, Groshong

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Hickman

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Valved Devices

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 Site Selection

 Exit point

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Client Preparation

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Insertion

 Video of Hickman
insertion technique
 Video of Groshong
insertion technique

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 Nursing Care
 Maintaining patency
 Dressing changes

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 Nursing Care

 Client
teaching
 Repairs
 Removal

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 1 2

3 4

6
5

7 36
Implanted Subcutaneous Ports

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 Advantages

 Cosmetic and
maintenance pluses
 Long life
 Low infection rate
 Low thrombosis rate
 NO activity limits

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 Disadvantages

 IR/OR placement
 Increased skill to
use
 Explantation

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 Indications and Use
 Long term, intermittent use with OR
placement
 Types
 Metal vs. plastic
 Side vs. top entrance
 Hi vs. lo profile
 Passport
 Cathlink

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Site Selection

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Insertion
 Video of subcutaneous port insertion

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Client Preparation

 Insertion
 Incision care

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 Nursing Care

 Accessing
 Straight vs. bent Huber needle
 Skin Desensitization
 Blood return
 Dressing

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 Boundaries

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Nursing Care
 Maintaining patency

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 Nursing Care

 De-accessing

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 Complications

 Twiddler’s
Syndrome
 Abscess
development
 Pop off of catheter
 Pinching off
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Dialysis Catheters

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50
 Temporary
 Permanent
 Larger diameter tunneled or
non-tunneled catheters used for
hemodialysis. Not routinely used
for infusion therapy
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Comparison of Catheters
Peripheral Central PICC Tunneled Port

At BS At BS At BS OR OR

$ $$$ $$ $$$$ $$$$$

Replace Replace Replace or Repair Replace

Repair
Arm Chest Arm Chest Internal
chest
Sclerotic Infection Infection Clotting Clotting
Veins
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 Potential Central Line Related
Complications

 Insertion related
 Pneumothorax
 Perforation
 Hematoma
 Catheter embolus

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PICC Phlebitis
 Symptoms

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 Treatment
Related
 Infection
 Symptoms

http://
www.meditheses.com/
997-962.htm
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 Discontinuing
and culture
obtainment

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 Prevention of Infection

 Aseptic Technique
 Tubing and Bag
Changes

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 Cleansing of connectionssssssss
 Cleansing of caps

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Obstruction
 Mechanical
 Drug precipitates
 Thrombotic

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 Obstruction

 Symptoms
 Dye Study

 Treatment
 Urokinase

 Prevention

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Thrombosis
 Symptoms: Edema of effected hand,
arm, shoulder and/or neck; tenderness
in area; inconsistent flow
 Treatment: Probable removal of
catheter

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Air Embolism

 Symptoms
 Prevention
 Treatment

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 Others

 Infiltration versus Extravasation

 Leaking Catheter
 Dislodgment
 Migration
 Malposition
 Cutaneous Response
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Care and Maintenance Issues

68
Initiating and Maintaining
Infusions

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 Obtaining Venous Specimens

 Stopping infusion
 Discarding
 Specimen collection

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Flushing
 Access Device
Cards
 “Stop and Go”
 Positive Pressure

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S
A
S
H
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NO Blood Return

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Frequency of Dressing
Changes

MONDAY, THURSDAY
WEEKLY
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Discontinuing Infusions
 Possibility of catheter embolus

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 Client Teaching

Valsalva Maneuver

Discharge teaching
Responsible others

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 Troubleshooting

 Don’t argue with it!! HELP!!

 Not sure what to
do???
Call the IV Team
 No hemostats!!!

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Documentation

 Assessments
 Flushing
 Site Care
 Any
manipulations
done
 Client Education

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 Case Studies
• Mr. H is a 19 year old admitted to the
surgical unit with multiple trauma following
an auto accident. As part of the medical
treatment, a triple-lumen central venous
catheter is inserted into the right superior
vena cava. The electronic infusion device
keeps alarming patient side occlusion.
What is the most likely cause of this
problem? What action should you take? 
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 Mr. K., a 58 year old, admitted to your unit for
treatment of respiratory distress related to
emphysema. He has been receiving antibiotics
for 4 days via the triple-lumen catheter placed
in the emergency department. When
assessing him, you note that his rectal
temperature has risen to 102.4F. He is
diaphoretic and complaining of chills and
fatigue. What is the possible cause of these
symptoms? What actions should be taken?

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Hands on Practicum with
Related Skills
 Dressing Changes (Oncology and ICU only)
 Flushing
 Initiating infusions
 Discontinuing infusions
 Obtaining Venous specimens (Oncology and
ICU only)
 Accessing and de-accessing subcutaneous ports
(Oncology only)

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