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l) At least every 8 hours document: solution, amount, infusion device, rate, site location, and condition of site and dressing 2. Central venous access devices (CVADs): access a central vein that empties into the superior vena cava a. Central infusion devices 1) Percutaneous (nontunneled) catheter: a single or multiple lumen catheter inserted by the physician at the client's bedside 2) Tunneled catheter: like all central lines, this catheter terminates in the central venous system; the remainder of the catheter passes through a subcutaneous tract and exits on the chest wall or abdomen; a dacron cuff on the catheter elicits scar formation that prevents ascending tract infection; this catheter does not require a sterile dressing once the sub-cutaneous tract has healed 3) Peripherally inserted central catheter (PICC): inserted in the basilic or cephalic vein just above or below the antecubital space of the right arm by a physician or specially trained intravenous therapy nurse and is used for longer term inpatient or outpatient therapy; although the insertion site is in the periphery, the catheter terminates in the superior vena cava 4) Implantable venous access devices or ports: surgically implanted into a small subcutaneous pocket, usually on the upper chest using local anesthesia; the port is attached to a catheter that
terminates in the central venous system; most subcutaneous ports are accessed with a Huber needle to preserve the life of the port septum 5) Peripheral access system (PAS) ports are similar to a subcutaneous port except the port itself is implanted in the antecubital area b. The internal tips of all central lines lie within the central venous system; placement can occur in numerous settings but all placements must be verified by x-ray c. Internal tips: the internal tip of the catheter comes in two versions 1) Open-tipped: the end of the catheter opens directly in the bloodstream; if flushing techniques are not performed correctly, blood can back up into the catheter causing catheter occlusion; there are two open-tipped catheters; they must be flushed with saline followed by heparin flush solution to maintain patency when not in use a) Hickman: the adult form of the open-tipped catheter b) Broviac: the pediatric version, which usually means smaller lumen size 2) Closed-tip catheter or Groshong: this catheter has a valve on its internal tip that prevents backflow of blood; Groshong catheters are routinely flushed with double volumes of saline but do not require the instillation of heparin flush solution; advantages of the Groshong catheter are: a) Decreased risk of air emboli or bleeding b) Elimination of heparin flush c) Elimination of catheter clamping d) Reduced flushing protocols between use d. Lumens: central catheters may have a single, double, or triple lumen: each lumen corresponds to a separate catheter and has a separate exit point 1) Multi-lumens allow for the administration of incompatible drugs 2) Blood drawn from one lumen will not be contaminated by the drugs administered through