Central Venous Access Devices
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| Sepsis | A severe blood infection caused by bacteria, viruses, and fungi. Extremely serious and can be life-threatening.
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| Manifestations of sepsis | Fever, chills, hypotension, tachycardia, and confusion.
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| Nursing interventions to prevent infection | Meticulous hand hygiene; clean injection ports with alcohol/chlorhexidine wipes and allow to dry before injections; USE ASEPTIC TECHNIQUE when working with device; assess for redness, swelling, or discomfort at insertion site.
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| Pneumothorax | Air in the pleural space (outside the lungs) caused by a puncture of the covering of the lungs
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| Manifestations of pneumothorax | Dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, and decreased breath sounds on the affected side.
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| Air embolism | Air that has entered the circulatory system caused when a CVC is open to the environment.
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| Manifestations of air embolism | Dyspnea, chest pain, tachycardia, hypotension, anxiety, nausea, dizziness, and confusion.
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| Nursing interventions for air embolism | Assess that catheter is intact and patent. Be sure to keep all but Groshong clamped. If embolsim is suspected, cap catheter, administer oxygen, place on left side in Trendelenberg position, and stay with patient while a colleague calls provider.
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| Why do you place patient with air embolism on left side in Trendelenberg position? | It helps trap the air in the apex of the right atrium rather than entering the right ventricle and then moving into the pulmonary arterial system.
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| Catheter occlusion | Obstruction that impedes flow in a CVC. Can be thrombotic or nonthrombotic,
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| Nursing interventions for catheter occlusion | Make sure catheter is not clamped or kinked. Have patient: turn head and cough; raise arms over head; take a deep breath; stand up; or change positions. Place in Trendelenberg position. May need to remove sutures/place stabilizing device.
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| Thrombosis | Obstruction caused by a blood clot inside cath or outside around the tip that blocks the lumen. Heparin/other chemicals may remove the block - if not, cath must be replaced.
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| Nursing interventions for thrombosis | Follow facility and CVC manufacturer's policies for volume and frequency of saline flushes, and concentration, volume, and frequency of heparin flushes. Use a positive-pressure devices whenever possible. Follow policy for infusing thrombolytic agent.
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| Nursing interventions for pneumothorax | Monitor vital signs, administer oxygen, and notify provider. It may be necessary to remove the CVC and have a chest tube inserted.
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| Drug precipitates | When incompatible medications come in contact with one another, a chemical reactin can occur and cause a precipitate to form, occluding the catheter. The provider might order a specific agent to to help unblock the occlusion.
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| Nursing interventions for drug precipitates | Designate and label each lumen for a specific infusion and flush the lumen after use. Follow facility's policies for the frequency and volume of flushes.
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