Central Venous
Access Device
Simonette G. Valentin, RN
Adult Infusion Unit
Objectives:
Upon completion participants should be able to:
Define what a Central Venous Access Device (CVAD) is
Identify types of CVAD’s and indications for use
Acquire basic knowledge of the care for CVAD’s
What is Central Venous Access Device
(CVAD) ?
CVADs are also known as Central lines.
CVAD’s are devices used to gain access to the central circulation.
A short or long term intravenous catheter inserted into a centrally
located vein with the tip residing in the lower 3rd of the Superior Vena
Cava (SVC) near its junction with the right atrium.
( Infusion Nurses Society 2011)
Indication For Use
Limited or difficult peripheral vascular access
Prolonged intravenous IV therapy
Frequent administration of blood and blood products
Frequent blood sampling
Measurement of CVP
Hemodialysis/Hemofiltration
Bone Marrow and Stem Cell Transplant
Where Are Central Venous Catheters
Inser ted?
Types of Central Venous Access
Device
Nontunneled
Central
Catheters
Tunneled
Central
Catheters
Peripherally
Inserted Central
Catheters
Implanted
Ports
Non-Tunneled Catheters

Also called percutaneous, acute-care, short-term or
temporary catheters.

Site placement is typically in either the subclavian
vein, internal jugular vein or femoral vein

Typically used for days to weeks

Single or multiple lumens
Tunneled Catheters
Advantages
Disadvantages
Can be inserted at
bedside
High risk for air embolism
Economical
Uncomfortable for the
patient
Easily removed
Requires dressing and
frequent assessment
Tunneled Catheters

Is a soft flexible tube

Site placement is typically in the subclavian
vein.

Silicone or polyurethane

Used for long term therapy

With small Dacron cuff

Hickman Line or Broviac
Tunneled Catheters

Single or multiple lumens

Inserted surgically
Tunneled Catheters
Advantages
Disadvantages
Does not require a needle
to access
Cosmetically visible
Can be left in place
indefinitely
Restrict activities
Self-care by patient
Requires dressing and
frequent assessment
PICC Line

It is long, slender, small and flexible tube.

Typically inserted in the upper arm.

Used for short or long term therapy.

Can be left in place for many weeks or months

Single or multi-lumen

Approximately 40-60 cm long.
Peripherally Inserted Central Catheter
Advantages
Disadvantages
Can remain in place for
several weeks to a year
Requires routine sterile
dressing and injection
cap change
Can be easily removed
Body image and activity
restrictions
Less traumatic to place
Patient self-care is
difficult
Implanted Ports
 Are long-term (months to years) single or dual chamber “port”
surgically implanted in the subcutaneous tissue, usually in the upper
chest and upper arm.
 Good for long term, intermittent therapy
 The maximum pressure for ports is 40psi.
Implanted Ports
With 4 components
 Portal Body
- Outer housing.
- Plastic, stainless steel or titanium.
.
- Single or double port.
 Septum
- Self sealing silicone center.
- Functional
 Reservoir
- A space underneath for access to the
circulatory system.
 Catheter
- It is radiopaque
Implanted Ports
 A Non-coring point needle is required to access the device
Implanted Ports
Implanted Ports
 Designed for multiple puncture
Implanted Ports
Advantages
Disadvantages
Cosmetically less noticeable and may
improve body image concerns
Needle access required
Probable lower risk of infection
High extravasation risk
Require less care and maintenance
Unrestricted activities
Surgical procedure required
to insert and remove
Key Principles of Care
Confirmation of placement

Chest x-ray

Fluoroscopy

Brisk blood return
Key Principles of Care
Aseptic and ANTT

5 Moments of hand hygiene

Aseptic Non-Touch Technique (ANTT)
Key Principles of Care
Cleaning Agent

2% chlorhexidine gluconate in 70% isopropyl alcohol

Povidone-Iodine

70% Alcohol
Key Principles of Care
Syringe size
Key Principles of Care
Dressing Materials

Transparent Dressing or TSM

Gauze or Non-woven fabric dressi
Central Line Dressing Change
Type of Dressing
Frequency
Initial
24 to 48 hours post insertion
Transparent
Non-Transparent
Every 7 days
PRN if damp, loosened, or soiled
Every 48 hours
Key Principles of Care
Line changes

Change IV line every 3 days.

Daily if with TPN.

Avoid disconnection and
connection of lines.

Do not reattached disconnected
lines.
Key Principles of Care
Caps/ Hub (Needless Connector) Changes
Key Principles of Care
Flushing

Pulsing Technique

SASH flushing Technique

Positive Pressure Technique

Heparin Lock
Key Principles of Care
Flushing
Pulsing Technique
Key Principles of Care
Flushing
Positive Pressure Technique
Key Principles of Care
Access (PICC Line)
1
2
3
6
5
4
7
Key Principles of Care
Access (Porta Cath)
Key Principles of Care
De - access (Porta Cath)
Key Principles of Care
Blood Sampling
Scrub the Hub
Attached 10 ml
syringe and unclamp
the clamp
Attach 10 ml syringe
and unclamp
Clean hub
Draw a waste
specimen of 5-10ml
of blood then
discard and clamp
catheter
Draw laboratory
samples
Clamp and clean
hub
Attach syringe and
flush catheter with 20
ml NS
Aseptic Non Touch
Technique
Key Principles of Care
Locking
Heparin lock
Type of CVAD
Heparinized Saline
Heparinized Saline
PICC Line
60 iu in 4 ml saline
600 iu in 4 ml in each
lumen weekly
Implanted Port
60 iu in 5 ml saline
600 iu in 5 ml every 4
weeks
If catheter in use
If catheter not in use
Key Principles of Care
Heparin Lock
Key Principles of Care
Assessment

Visually examine and carefully palpate insertion site daily
for erythema, drainage, tenderness, warmth and edema.

Routinely assess condition of dressing and securement device.

Catheter measurement for PICC line.

Routinely assess for blood return and patency.
Key Principles of Care
Documentation









Product Name
Date of insertion, inserter
X-ray confirmation of catheter tip location
‘Ready for use’ documented
Total and External Length
Mid arm circumference
Amount, type, and frequency of flush solution
Dressing and tubing changes
Site assessments
Test Your Learning
1. Which of the following is NOT a type of CVAD?
a). Tunnelled catheter
b). Epidural infusion
c). PICC
d). IVP
2. Pulsatile technique refers to
a). The stop/start method of flushing a CVAD
b). Checking a patient’s pulse before using a CVAD
c). Flushing a CVAD before and after accessing
d). Flushing a CVAD to determine patency
Test Your Learning
3. Pulsatile technique is used to
a). Block a CVAD
b). Create turbulence in the syringe
c). Create turbulence in the CVAD to reduce
blockage
d). Determine patency of a CVAD
4. The minimum sized syringe used when accessing a CVAD is
a). 3ml
b). 10ml
c). 5ml
d). 20ml
Test Your Learning
5. The only type of needle that should be used to
access an Implanted Venous Port is a
a). Non-coring needle
b). Intravenous needle
c). Hypodermic needle
d). Butterfly needle
6. CVAD dressings should be changed (more than
one answer may be correct)
a). Every day
b). 24 hours post insertion, then every seven days if
dressing remains dry and intact
c). Every 72 hours
d). If gauze is present beneath the occlusive
dressing every 48 hours
Test Your Learning
7. When a CVAD is used for blood sampling, the first
5 - 10 millilitres of blood is
a). Never discarded
b). Discarded when taking blood for blood cultures
c). Discarded when taking routine blood tests
d). Always discarded
8. After blood sampling a CVAD should be flushed in
a pulsatile manner with?
a). 10ml – 20ml normal saline
b). 20ml weak heparin saline
c). 15ml normal saline
d). 5ml normal saline
Test Your Learning
9. Primary IV tubing is changed q72hours (except
blood, TPN).
TRUE or FALSE
10. The tip of a PICC rests in the:
a). Radial artery
b). Jugular vein
c). Superior vena cava at the junction of the right
atrium
d). Femoral artery at the junction of the right atrium
Thanks!
Any questions?
You can find me at: @username
myemail@domain.com
Key Principles of Care
Confirmation of placement
Aseptic technique when handling CVADs
Cleaning Agent
Dressing Materials
Syringe Size
Dressing Changes
Line Changes
Caps/ Hub Changes
Access
Blood Sampling
Flushing and Locking
Assessment
Documentation
Key Principles of Care
Dressing Materials
Key Principles of Care
Stretch Technique
Key Principles of Care
Caps/ Hub (Needless Connector) Changes
Aseptic Technique
 Change caps/ hub every 72 hours
 TPN/ Lipid
 Blood Culture

Key Principles of Care
Flushing and Locking