Originally Created By: Sheila Elliott MN, RN
Revised By: Tina Haayer, RN, BScN
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What is the definition of a CVAD?
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What are the different types of CVADs?
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Why are CVADs used?
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How do you care for the different types of CVADs?
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What are the complications associated with CVADs?
A
venous access device whose tip
lies within the lower third of the
vena cava (superior or inferior) or
the right atrium. (Dougherty, 2006)
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PICC – Peripherally Inserted Central Catheter
Short-term, non-tunnelled CVAD - inserted
directly into a central vein
Long tern, tunnelled CVAD – inserted under
the skin
IVAD – Implanted Venous Access Device
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Inserted in antecubital
region and threaded into
central circulation
Very soft and flexible,
easily damaged
Lower risk of infection
No BP’s or venipuncture
on that arm
May be removed by RN
once observed
Single or double lumen
May be an open or a
closed system
Tip
Insertion
Open-ended
Non-Groshong
Closed-ended
Groshong
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Inserted into jugular, femoral
or subclavian vein
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Left in place until
treatment complete,
or complications occur
Located beneath the
subcutaneous tissue
Appears as a palpable
protrusion under the
skin
Lower risk of infection
May only be accessed
with a non-coring
needle
Needles to be changed
every 7 days, or every
day if infusing
TPN/blood products
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Reliable for patients requiring long term
access (eg: chemotherapy, TPN)
Emergency access and for rapid infusion of
fluids or blood products
To monitor central venous pressure
To provide venous access for patients who
have poor peripheral venous access
Patient preference
ADVANTAGES
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Reliable long term
access
Used for multiple
blood samples
Used for blood
products, meds, TPN &
fluids
Removes need for
constant venipuncture
or peripheral
punctures
DISADVANTAGES
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↑ risk of infection
↑ risk of thrombus
Exposes patient to risk
during insertion
(pneumothorax)
Can affect body image
Can be traumatic to
patient and may
require general
anesthetic for insertion
 (Dougherty, 2006)
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Prevention of infection
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Maintaining patency
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Preventing damage
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Strict handwashing
Use sterile technique
Change dressings as recommended
Occlusive dressing over exit site
Keep system closed as much as possible
Change tubing, solutions and injection caps
as recommended
Monitor for early signs of sepsis
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Patency is the ability to:
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Maintain patency with saline flushes:
◦ Infuse through a catheter
◦ Aspirate blood from a catheter
◦ Prior to and after meds, TPN, etc.
◦ Before and after blood draws
◦ Refer to hospital policy
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Methods of flushing include:
◦ Turbulent or pulsatile flush (creates turbulence and ↓
potential for debris to stick to inside or tip of catheter)
◦ Positive pressure (prevents backflow of blood into end of
catheter)
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Proper securement of CVAD is vital in preventing
the following complications:
◦ Catheter migration
◦ Phlebitis
◦ Damaged catheter
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L. Dougherty. (2006). Central Venous Access
Devices: Care and management. Oxford,
UK: Blackwell Publishing Ltd.