Venous access devices: Clinical rounds

Abstract

Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented.

Comparison Between Internal Jugular and Upper Arm Peripheral Veins Approach in Insertion of Totally Implantable Central Venous Ports

“…12 Catheter infection and occlusion rates were also observed, and they were mostly attributed to inadvertent mishandling of the port during the service interval; and this led us to recommend more effort to teach and train medical staff on how to use the devices safely and properly, with emphasis on how to access the port under strictly sterile conditions and on filling the system with heparinized sodium chloride after usage to prevent potential problems in the long-term management of the port. 13 No complications regarding a breakdown of the port system were reported, and there was minimal drug leak (one case only) noted over the observation period of 1 to 24 months in our series. This is probably because the main healthcare providers privileged to deal with TIVP patients at our institute are all highly trained in the use of several types of TIVP systems, and thereby mechanical damage to the port system could be avoided.…”

Comparison between Internal Jugular and Upper Arm Peripheral Veins Approach in Insertion of Totally Implantable Central Venous Ports

“…12 Cath infection and occlusion were observed, describing this circumstance to an inadequate handling of the port during the service interval; maybe more effort should be made to teach medical staff how to use the devices safely and properly, with emphasis on how to work strictly sterile when puncturing the port and on blocking the system with heparinized sodium chloride potential problem in the long¬term management of the port. 13 No complications regarding a breakdown of the port system and there was minimal drug leak (one case only) occured noted over the observation period of 1 to 24 months in our series. This is probably because the main users of TIVP at our institute were all highly trained in the use of several types of TIVP systems, and thereby mechanical damage to the port system could be avoided.…”

Care Protocol With Totaly Implanted Venous Catheter: A Collective Construction

“…Antisepsis should be performed using a 0.5% alcohol chlorhexidine solution, starting the technique in the central region of the CVC-TI implantation, in increasing circular movements up to a diameter of 10 cm, three times, and waiting 30 seconds for the spontaneous drying of the solution. 5,18 When puncturing the device, the practitioner should initially evaluate its operation by aspirating all the solution contained in the chamber (average, 5 ml in adults and 3 ml in children) or even refluxing blood to avoid complications. Finally, they should install the prescribed serum and medication circuit, protecting with sterile gauze and securing the puncture device with micropore or sterile transparent polyurethane film (in case of a hospitalized client).…”