Special considerations include examining the expected length of treatment the specific prescribed treatment and the client’s vascular characteristics, age, cognitive level, medical history, infusion therapy history, and, if appropriate, their preference for the CVAD site location. The decision process for selecting an appropriate CVAD involves collaboration among the provider, the client, and the health care team while considering the treatment requirements. The type of CVAD selected is based on the specific client’s clinical situation. There are several types of CVADs, and the selection of which type is used depends upon the specific client’s clinical situation, indication, and duration of treatment. Types of Central Venous Access Devices and Locations Central venous pressure (CVP) reflects the pressure in the central veins as they enter the right atrium and is often monitored during fluid resuscitation as measure of preload (i.e., volume status). Hemodynamic monitoring is the assessment of a critically ill client’s circulatory status and includes measurements of central venous pressure, cardiac output, and blood volume. Hemodynamic monitoring is often in place when a client requires fluid resuscitation. When these solutions enter this larger vessel, the solution is hemodiluted, thus minimizing the risk of these complications from occurring.įluid resuscitation refers to infusing a large volume of fluid through the intravenous venous access to restore hemodynamics and optimize tissue perfusion and, ultimately, tissue oxygen delivery. For this reason, infusions of high osmolarity solutions and vesicant medications are administered through a CVAD into a large vein such as the superior vena cava. Extravasationrefers to leakage of fluid into the tissues around the IV site, causing tissue injury when the catheter has dislodged from the blood vessel but is still in the nearby tissue. Additionally, vesicant medications (such as certain antineoplastic drugs, antibiotics, electrolytes, and vasopressors) can cause severe tissue injury or destruction if they extravasate. High osmolarity solutions, such as total parenteral nutrition and hypertonic IV fluids, are irritating to peripheral vessels and increase the client’s risk for phlebitis, thrombosis, and occlusion. High osmolarity solutions refer to a highly concentrated solution expressed as the total number of solute particles per liter. Many clients who require CVADs are older adults, very young children, or those with chronic health conditions. They may also be placed for emergency venous access for clients requiring fluid resuscitation and hemodynamic monitoring. CVADs are required for infusion of high osmolarity solutions and vesicant medications. Common indications for CVAD placement include delivery of medication, fluids, and nutrition, especially for clients requiring long-term therapy.
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