Unit 6 - LPNC LPNC UnitSix CentralIntravenous Therapy

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LPN-C LPN-C Unit Six Central Intravenous Therapy
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2 Central Venous Access Central Venous Access 5 million central venous access  devices (CVADs) are placed each year Increasing as the population ages Uses for central venous routes Fluids Medications Blood/blood products Chemotherapy Nutrition Blood samples (frequent lab tests) Cardiac/pulmonary function assessment Can be used repeatedly and for long  periods of time
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3 Risks/Benefits of CVAD Placement Risks/Benefits of CVAD Placement Indications for placement of a central  venous catheter (CVC) Inadequate peripheral vascular access Need for frequent vascular access Hypertonic/hyperosmolar infusions Infusion of irritating or vesicant drugs Rapid absorption and blood/tissue  perfusion Long-term IV therapy Contraindications for placement of a  CVC Altered skin integrity Anomalies of the central vasculature
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4 Risks/Benefits (cont’d) Risks/Benefits (cont’d) Contraindications (cont’d) – Immunosuppression, septicemia Problems with coagulation Clavicle fracture Hyperinflated lungs Radiation to the insertion site area Superior vena cava syndrome History of venous access device  complications Main types of CVADs Centrally inserted catheters Peripherally inserted catheters Centrally implanted ports
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5 Nontunneled Catheters Nontunneled Catheters *Single or multilumen nontunneled  CVCs can be silicone or polyurethane Inserted into the venous system from  the subclavian or jugular vein by a  percutaneous stick The tip of the catheter is then  advanced into the superior vena cava Example: a  Hohn  catheter Referred to as central lines, CVCs,  permanent indwelling catheters, or  percutaneous central venous  catheters Catheter size ranges from 24 gauge 
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7 Tunneled Catheters Tunneled Catheters *Single or multilumen central venous  tunneled catheters (CVTCs) are  usually made of soft silicon Dacron cuff near exit site anchors  catheter in place, acts a securing  device, and serves as a microbial  barrier Surgically inserted via percutaneous  cutdown under local or general  anesthesia Catheter tip placed in the superior  vena cava, while the other end is  tunneled subcutaneously to an 
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8 Tunneled Catheters (cont’d) Tunneled Catheters (cont’d) Left in place for indefinite period of  time Examples are the  Broviac Hickman and  Groshong The Groshong catheter allows fluids  to flow in or out, but stays closed  when not in use Reduces need for clamping No need for heparin flushing NS flush every 7 days when not in use Also available in nontunneled form
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Unit 6 - LPNC LPNC UnitSix CentralIntravenous Therapy

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