Central Venous Access Devices (CVADs)
Workbook & Competencies
This workbook has been issued to:
Name___________________________________ Grade________________ NMBI_______
Date of Issue______________________________ Ward_____________________________
Name(s) of Assessors (Please print)
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………....
…………………………………………………………………………………………………………………………………..............
For audit and verification purposes, please complete the above section.
You are reminded that only staff that have attended the Intravenous Therapy Management
Programme Study Day, have completed the Clinical Skills Workshops and have been deemed
competent in Intravenous therapy via Central Venous Access Devices should assess you.
Central Venous Access Devices
This section introduces Central Venous Access Devices. Anatomy and physiology are discussed
together with reasons for choosing the central route. Procedure for insertion, monitoring and
removal are discussed in detail.
NB: This workbook should be used in conjunction with TSCUH Medication Policy, Central Venous
Access Device Guideline and care plans relevant to each device.
Learning Outcomes
After studying this section the practitioner will be able to:

Describe the reasons for using central venous access devices and the common
insertion site

Describe in detail the procedure for insertion, monitoring, blood sampling from and
removal of an acute central venous catheter (CVC)

Explain the complications associated with CVADs

Describe the maintenance care of CVADs in relation to care of site and maintaining
patency
Definition of Central Venous Access Devices (CVADs)
A CVAD is described as a short or long term intravenous catheter inserted into a centrally located
vein with the tip residing in a central vessel in the chest that immediately connects with the right
atrium. This is usually the Superior Vena Cava (SVC)
Fig 1. Common sites for Central Venous Catheter Device Insertion
Reasons for Central Venous Access Devices
If peripheral venous access is unavailable, poor or difficult
Reliable venous access in the acutely ill patient
Allows multiple and continuous infusions to be delivered simultaneously
Rapid administration of fluid and/or blood products
Regular blood sampling
Administration of hypotonic and hypertonic solutions
Administration of medications with extreme pH or osmolality which would cause severe
phlebitis if given peripherally
Administration of vesicant and irritant medications e.g. chemotherapy
Parenteral nutrition administration
Central venous pressure (CVP) monitoring
Long term antibiotics
IV therapy in the community
Therapeutic procedure e.g. bone marrow / stem cell transplants
With increased use of CVADs we now see a diversity of catheter devices available to provide
central venous access. However, these catheters are not without risk.
All types of IV catheters are associated with catheter related blood stream infection (CRBSI).
CVADs are associated with a higher rate of CRBSI than peripheral IV catheters therefore
interventions to reduce the rate of CRBSI are especially important for their management and care
(Maki, et. al, 2006).
CVAD complications range from mild local irritation to blood stream infections associated with
significant mortality and morbidity. It is imperative that nurses involved in the care of CVADs are
competent to do so, because practice vigilance is critical in reducing and preventing complications
(Robert, et al., 2000).
The CDC-Guidelines for the Prevention of Intravascular Catheter–Related Infections
Vol:51 No RR-10 2002, (p5) state ‘inexperienced staff increase the risk for catheter
colonization where well organized Quality Assurance and Continuing Education programmes
enable health-care institutions to provide, monitor and evaluate care and to become educated
for successful outcomes. Specialised teams have shown unequivocal effectiveness in reducing
the incidence of Catheter related infection and complications.
Other Complications associated with CVADS
Air Embolism
Haemothorax (vessel pierced during insertion)
Pneumothorax (pleura pierced during insertion, IJV/ subclavian veins)
Cardiac Arrhythmias (particularly if catheter tip moves into right ventricle)
Catheter migration
Haemorrhage
Chylothorax (Thoracic lymph duct injury during insertion)
Types of CVADs
CVADs come in different sizes with either single or multiple lumens. With multiple lumens, each
lumen provides independent access to the venous circulation. This allows two incompatible drugs
or fluids to be infused simultaneously. As a general principle the lumen diameter and number of
lumens should be kept to a minimum as multiple large bore catheters are associated with a higher
risk of infection and thrombosis (Simcock, 2001). However, in PICU settings, multiple lumen large
bore catheters tend to be used because they are essential for management of acutely ill patients.
The following CVADs are available for use in TSCUH
Peripherally inserted central catheter (PICC)
Non tunnelled central venous catheter e.g. Arrow®
Skin tunnelled central venous catheter e.g. Hickman®, Broviac®
Implanted port e.g.Vygon Sitimplant®
Dialysis catheters which are procedure specific
Fig 2.
Commonly used CVADs
Insertion of all CVADs is carried out under Maximal Sterile Barrier (MSB)
conditions
PICCs:
Inserted at ward level by the accredited PICC nurse vascular access team
Anaesthetists / Intensivists also insert PICCs in the operating theatre or intensive care unit.
PICC is a catheter that is inserted into a peripheral vein e.g.basilic, cephalic, brachial veins etc. and
advanced into the central veins with the tip located in the superior or inferior vena cava. The exit
site for PICCs is directly above the entry into the vein and they are not tunnelled through the
subcutaneous tissue. Suitable for several weeks/months of intravenous use. (Dougherty & Lister
2011)
Non-tunnelled CVC
Inserted in operating theatre, ICU, or emergency department by Anaesthetist /Intensivist.
A non-tunnelled or short term vascular access device (usually <14 days) that is inserted into the
internal jugular, subclavian or femoral vein with its tip in the superior vena cava adjacent to the
right atrium, (inferior vena cava in the case of femoral insertion). The skin exit site is directly
above where the catheter enters the vein. Vascaths are another non-tunnelled short term type of
CVAD inserted for haemo filtration and /or plasma exchange. Available in single, double, triple and
quadruple lumens.
Tunnelled catheters:
Hickman® or Broviac® inserted by the paediatric surgeons in the operating theatre.
A skin tunnelled catheter that lies in a subcutaneous tunnel before being placed in the internal
jugular or subclavian vein and advanced until it lies in the superior vena cava adjacent to the right
atrium. The tunnel acts as a barrier to infection. The catheter has an integral Dacron cuff which
sits in the subcutaneous tunnel. Tissue granulates around the cuff and reinforces the barrier to
invading organisms and reduces the risk of the catheter dislodging. Available with single, double
and triple lumens. Suitable for months/years of intravenous use.
Implanted Ports
Inserted in the operating theatre by the paediatric surgeons.
A port is a totally implantable vascular access device which is inserted either on the chest wall or
antecubital area with its tip situated in the superior vena cava. The implanted port is accessed
through the skin using a special non-coring (Huber) needle when therapy is required.
Suitable for long term (years) of intravenous use.
Table 1: Equivalent Gauge and French size
Equivalent Gauge and French sizes of vascular access devices
Gauge (G)
23g
20g
18g
16g
11g
French (Fr)
2fr
3fr
4fr
5fr
9fr
Source: Gabriel et al (2005)
CATHETER MATERIAL IS EITHER SILICONE OR POLYURETHANE
Silicone: Is soft and pliant and is resistant to many chemicals such as ethanol, is less thromboresistant, has poor tolerance to pressure (ruptures easily) and drugs can leach into material
Polyurethane: Has good tensile strength, is wear and kink resistant, softens in the vein, is
thrombo-resistant, has higher flow rates and a high degree of biocompatibility
TIP POSITION OF A CVAD MUST BE RADIOLOGICALLY VERIFIED PRIOR TO USE
Knowledge of anatomy, physiology and the principles of blood flow are essential for safe
management of all Central Venous Access Device.
ACTION: LOCATE THE FOLLOWING VEINS IN THE DIAGRAM BELOW
RIGHT INTERNAL JUGULAR VEIN, LEFT SUBCLAVIAN VEIN, SUPERIOR VENA CAVA
Fig 3. Major Central Veins
Veins and Valves
Veins are known as reservoir vessels with approximately 65% of blood volume found in the
venous circulation system. The vein walls distend six to ten times more than arterial walls with
only the smallest amount of pressure. This means that normal pressure is re-established quickly,
for example following the release of a tourniquet. This is referred to as a ‘Stress Relaxation
Phenomena’.
The veins also have what is referred to as a muscle or venous pump. When muscles contract they
compress the vein. This helps return blood to the heart. When a muscle contracts, proximal valves
open while distal valves close.
This action can specifically affect the PICC causing it to migrate either in or out of its correct tip
position if it is not well secured.
Muscle action is also responsible for reflux of blood into the tips of CVADs.
Pressure from the contracting muscle forces the ‘locking fluid’ out of the catheter lumen allowing
blood to reflux into the CVAD when the muscle relaxes. The vein and catheter are two distinct
flow systems, each vulnerable to occlusion (Hadaway, 2005).
Valves are structures within the lumen of the vein which are formed by the endothelial lining of
the Tunica Intima. They are present as bumps usually found at vein bifurcations and
predominantly found in large veins of the extremities. There are approximately 40 venous valves
between the hand and the axillary vein. Larger veins of the central vasculature do not have valves
Fig 4 Comparison of structure of arteries (a) and veins (b) with vein valve mechanisms (c)
Fig 5 Cross section of vein
1. The Tunica Intima (Interna) is the delicate inner lining of the vein which can become damaged
by mechanical, chemical or bacterial means. The damage causes bleeding into the interstitial
compartments of the basement membrane.
2. The Tunica Media has muscle and connective tissue which forms the bulk of the vein
3. The Tunic Adventitia (Externa), rich in nerves provides the pain pathway.
All three layers can be affected giving rise to phlebitis
Physiology of the Inflammatory Process
Fig 6 Inflammatory Process
Source: Johnson & Johnson Medical
Phlebitis is the result of an inflammatory process of the intima of the vein due to irritation to the
endothelial cells (refer figure 6). It is classified according to its causative factors.
The 3 causative factors are:
Chemical
Mechanical
Bacterial
CVAD are inserted into an appropriate vein and advanced along the venous system until the
catheter tip reaches its destination in the lower 1/3rd of the superior vena cava and occasionally
the inferior vena cava. The superior vena cava in adults is on average 20 mm in diameter and has a
high blood flow of approximately 2000 mL/min which is far greater than in a peripheral vein.
This means that irritant drugs and fluids, those with concentrations of solutions with extremes of
pH or osmolality can be infused without damaging the SVC vein wall due to this increased
haemodilution.
Blood flow is primarily affected by the following:
Diameter and shape of the vessel. When the vessel doubles in diameter, the flow rate
increases sixteen times and is known as ‘Poisuille’s Law’ or ‘Fourth Power Law’
Blood viscosity. As blood viscosity increases, flow rates decrease due to resistance.
Flow rates. Described as either laminar or turbulent.
Fig 7 Poiseuille’s Law
Laminar Flow
This is described as the normal movement of blood through a cylindrical vessel while taking
account of the resistance exerted by the walls. In simple terms the blood touching the vessel wall
moves slightly slower because of friction from cells lining the vessel wall. Blood in the centre of
the vein moves the fastest and with least resistance.
Turbulent Flow
This describes a flow pattern which is created in a variety of circumstances. For example when the
inner layer of the blood vessel is rough; an obstruction is present; when there is a sharp turn in a
vessel or when the flow rate is greatly increased. Higher velocity of blood flow, larger diameter of
the vessel and lower viscosity all increase the potential for turbulent flow for example the flow in
the SVC
Fig 8. Laminar and Turbulent Blood Flow
Refer to above when CVAD flushing techniques being detailed later in book.
Infection Prevention and Control
CVADs are frequently used in healthcare, but as they breach the body’s skin defences they create
a potential entry point for infection. Around 20% of healthcare associated blood stream infections
are linked to the use of a CVC – referred to as catheter related blood stream infection (CRBSI).
CRBSI occur when bacteria grow in an intravenous central line and spread to the patient’s
bloodstream. The microorganisms that colonise catheter hubs, access devices and the skin
adjacent to the insertion site are the source of most CRBSI along with the colonised hands of
healthcare workers (refer to figure 9). These infections worsen the patient’s underlying health
problem, prolong hospitalisation and increase the cost of care. In addition the mortality rate
attributed to CRBSI is around 10%.
Fig 9 Sources of Infection (Source Unknown)
An evidence-based approach underlies the strategies for the prevention of CRBSI. Interventions
are based on the concept of ‘bundles’ of care components which incorporate individual practices
that together result in greater improvements than when used individually.
There are two care bundles of components aimed at the prevention of CRBSI (Institute for
Healthcare Improvement, 2008)
CVAD insertion bundle
Hand hygiene
Maximal barrier precautions
Chlorhexidine skin
antisepsis
Optimal catheter site
selection
85% OF BACTERIA FOUND ON THE SKIN ARE RESPONSIBLE FOR CRBSI
CVAD maintenance bundle
Daily review and documentation of line necessity and prompt removal of unnecessary
lines
Access the CVAD lumens and hub aseptically using chlorhexidine 2% and alcohol 70%
wipes (Clinell®) with vigorous friction prior to access, allow to dry
Review and document each shift the entry site (CVC/PICC) exit site (Hickman/Broviac)
and surrounding area for inflammation
Use of sterile occlusive transparent, semi permeable dressing on insertion site,
changed weekly or when moist / loose
Other CVAD infection prevention principles include:
Hand hygiene before and after manipulation of CVADs and administration set using the
5 Moments approach
Use of sterile gloves and sterile field for all CVAD access and medication preparation
The use of personal protective equipment
Five CVAD moments for hand hygiene
Moment 1: Before Touching a Patient
• Touching a patient in any way or any invasive medical device connected to the patient (e.g. IV pump)
Moment 2: Before a Procedure / Aseptic technique
• Insertion of a needle into an invasive medical device e.g. port access, IV flush
• Preparation and administration of any medications given via an invasive medical device, or preparation of
a sterile field
• Insertion of, or disruption to, the circuit of an invasive medical device
Moment 3: After a Procedure or Body Fluid Exposure Risk
• After accessing a CVAD or undertaking the dressing
Moment 4: After Touching a Patient
Moment 5: After Touching a Patient’s Surroundings
ASEPTIC NON TOUCH TECHNIQUE (ANTT)
Aseptic Non Touch Technique (ANTT) is a technique that maintains asepsis and is non-touch in
nature and performed in a logical order.
– Always wash hands effectively
– Never contaminate key parts
– Touch non key parts with confidence
– Take appropriate infection prevention precautions
ANTT is used when:
Drawing up from plastic poly amps e.g. saline, water
Transferring diluents into drug bottles
Drawing up from drug bottles and transferring drugs to IV bags
Administering medication via the access device on a peripheral venous cannula
Flushing a peripheral venous cannula
Blood sampling from a peripheral venous cannula
Cleaning all access ports with friction using chlorhexidine 2% and alcohol 70% (scrub the
hub)
In TSCUH
all nursing procedures
Principles
of Maintenance
and Carerelating to CVADs care are carried out using sterile
field and sterile gloves with ANTT for maximum asepsis
Following CVAD insertion the following information should be recorded in the patient’s HCR,
The following information should be documented by the inserter of the CVAD in the patient’s
HCR post procedure
Date of insertion
Type and size of device
Vessel used
If the catheter length has been altered (Implanted port))
Radiologically confirmed tip location
Details of insertion should be completed by inserting clinician (asepsis details)
Principles of Care and Management of CVADs
Management of Central Venous Access Devices requires us to maintain the patency of the
catheter and vein (Hadaway, 2005).
Knowledge and good assessment skills are essential when caring for a CVAD.
Pre insertion education for patient and parents
Assess the patients general skin condition pre CVAD insertion , if skin is dirty ensure it is
washed with warm soapy water prior to insertion of CVAD
Ensure the patient and / or family understand what is involved in the process and what to
expect during and following insertion
For children this will include an-age appropriate explanation and may involve the hospital
play specialist (elective CVAD insertion)
Use a catheter diagram to explain what the catheter looks like, where it will be inserted
Explain how the catheter will be cared for i.e. flushing, dressing and securement
Encourage the patient/ family to report any thing that doesn’t ‘feel right’ or concerns them
Ensure the patient / family is given the appropriate CVAD patient information booklet
Instruct the patient/ family to always wash their hands prior to touching the catheter
Monitor patient’s hydration status as dehydration may make cannulation of a vein more difficult
It may be required to check the patient’s haemoglobin, platelet count and coagulation studies
prior to insertion of a CVADs, check with the patient’s medical team to ascertain if this is required.
Post Insertion
Check catheter insertion site for:
Bleeding
Swelling
Bruising
Pain or discomfort
Dressing integrity
On-going assessment of the CVAD
The CVAD must be assessed at least once per shift when not in use and in addition:
Prior to administration of medications and fluids
During continuous infusions
During the administration of vesicant drugs
During dressing changes
During access device changes
The appropriate way to assess the insertion site for infection is to visually inspect it and palpate it
through the dressing (category IB, CDC Guidelines 2002)
Assess the insertion site and area beyond
For signs of infection, redness, leaking, swelling, induration
The neck, shoulder and extremity on side of catheter insertion for swelling, pain,
thrombosis
PICCs: all the above plus the mid upper arm, axillary area and hand for swelling or
phlebitis. Check the external catheter length each shift and document findings
Ports: the portal pocket
Document any variances in the patients care plan
Protect the catheter during showering
Avoid the catheter and dressing becoming wet. Don’t submerge the catheter in water. Teach the
patient /parent how to protect the catheter by covering it with plastic wrap or a plastic sleeve (for
PICCs) and avoiding direct water contact for other devices (category IB, Centre for Infectious
Disease (CDC) Guidelines, 2002)
Dressings
An aseptic non-touch technique (ANTT) with sterile dressing pack and sterile gloves is used when
dressing the catheter
Change dressing when:
Weekly as routine and more frequently if;
Loose
Visibly soiled
Lifting from site
Excess oozing at insertion site
Cleaning the exit site, surrounding skin and catheter
Use 2% Chlorhexidine & 70% alcohol swabs or solution
For infants < 2months corrected gestational age, use 0.5% chlorhexidine in aqueous
(Sterhexidine®)
Clean the skin using friction. Either circular or grid method is acceptable (INS.2010).
Do not contaminate the insertion site. Clean along catheter length that sits under dressing
Allow to air dry for 15-30 seconds. Do not wipe the solution off (CDC Guidelines
Recommendations)
If blood is present at or around the insertion site, use STERILE WATER to clean and remove
blood, then clean site with 2% Chlorhexidine & 70% alcohol swabs.
Chlorhexidine 2% has demonstrated continued activity for up to six hours after application
A sterile occlusive transparent semi-permeable dressing is applied to the catheter insertion
site to protect the area and allow for visualization and early detection of complications.
Catheter Securement
Catheter securement is a critical component of successful dressing management during all
phases of catheter use, including dressing removal and site antisepsis. Catheter securement is a
care issue that includes patient variables, practice variables, and product variables (Macklin,
Blackburn 2015).
The dressing protects the insertion site, but the catheter securement system directly
influences dressing management especially during dressing removal. Lack of movement of
the catheter promotes healing at the insertion site allowing the new tissue to act as a
barrier to surface bacteria. Three complications associated with securement are:
Catheter migration
Catheter related blood stream infection
Thrombosis
Ensure that sutures are checked and remain intact for non-tunnelled CVADs to minimise to and fro
pistoning of the catheter and subsequent catheter tract invasion by cutaneous micro-organisms
(HPSG 2009)
For PICCs check that the steristrips and dressing are dry and intact to prevent movement of
catheter
Catheter hubs carry the highest risk for infection and should be protected
from contamination at all stages of the changing procedure (CDC Guidelines 2010
SCRUB THE HUB
Organisms can be introduced via the catheter hub. In TSCUH a needle free system (Microclave®) is
attached to all IV devices. It is essential to vigorously clean the needle free device and its luer
threads using an antimicrobial wipe (Clinell®) before attaching syringe to access CVAD. This luer
lock device should be changed weekly using full asepsis.
Blood sampling from CVAD
Blood sampling can be carried out safely and effectively in CVADs larger than 3Fr. For smaller
PICCs there is an increased risk of a thrombotic occlusion and it is not recommended. Before
obtaining a blood sample for laboratory analysis, a blood discard is necessary (see below
exception for blood culture sampling). The Infusion Nursing Society’s standard (2011) is to discard
1 to 3mls blood or 2 times the internal volume of the catheter and any add-on devices (taps,
extension sets). Immediately following the blood sampling flush with adequate volume of normal
saline to clear the line completely of blood and follow with a lock solution if the CVAD will not be
in continuous use.(Check with patient’s medical team for recommendations)
When obtaining a blood culture from a CVAD, a sterile technique must be used
to avoid contaminating the specimen. A blood discard is not recommended and first
sample is sent for culture. Infusion Nursing Society’s Standards for Practice (2016)
recommends that the needle free device be removed from the CVAD before obtaining
blood for blood culture and that sample is taken directly from the CVAD hub to avoid
contamination of the specimen through a potentially colonised device
CVAD Flushing techniques
Syringe size
A syringe size of 10mls minimum must be used when flushing the CVAD and excessive force must
not be used, otherwise catheter rupture can occur (Dougherty 2006).
Infusion pressure should not exceed 25 pounds per square inch (psi). A 10ml syringe generates
pressure of less than 8 psi while small syringes generate very high pressure with very little force.
The back pressure from an occlusion (blockage) may not be felt when using a small bore syringe
until after catheter damage has occurred.
Exceptions may be required when administering antibiotic locks and /or Urokinase solutions (check
with Inserter)
Flushing and maintaining patency
Using the correct techniques to flush CVADs has been highlighted as one of the key issues in
maintaining catheter patency. There are 2 stages in flushing;
1. Using a pulsated (push – pause) flush to create turbulent flow when administering the
flush solution regardless of type or volume. This removes debris from the internal catheter
wall which helps prevent occlusion. Administer 1ml of solution, pause for 1 second and
repeat until appropriate volume has been administered.
2. The procedure is completed using the positive pressure technique when administering the
final saline or heparinised saline flush solution. This is accomplished by maintaining
pressure on the plunger of the syringe while closing the clamp on the catheter lumen and
disconnecting the syringe from the needle free device as the last 0.5ml of flush solution is
being instilled. This technique creates a positive pressure within the catheter lumen
preventing reflux of blood into the tip thereby reducing the risk of occlusion
3. The clamp on each catheter lumen must be kept closed at all times when the CVAD is not
in use (no continuous medication infusion being administered) to maintain positive
pressure in the line. The clamp is closed between flushes, while disconnecting an IV
infusion set, changing a needle free device also. The position of the clamp should be
moved regularly on non-tunnelled CVADs to prevent the line kinking in places however the
clamp must only be closed over the reinforced catheter sleeve on Hickman / Broviac
catheters to prevent damage to the catheter length.
4. Flush solutions, volumes and frequency should be prescribed by the clinician in the
patient’s drug prescription chart.
Removal of CVADS
CVADs are removed when clinically indicated by the patient’s medical team. This may be following
discontinuation of infusion therapy, when deemed no longer necessary for the plan of care and/or
as a result of complications e.g. CRBSI.
Routine Collection of the CVAD tip is not required when removing the device. If a
CRBSI is suspected the medical team may request that the tip is sent to microbiology lab for
culture (HPSC 2009)
Tunnelled CVADs and Implanted ports are removed in theatre under general anaesthetic.
Non-tunnelled CVADs and PICCs should be removed by nursing staff deemed competent in the
care and removal of CVADs.
Explain procedure to patient and family
When removing a CVAD the patient should be placed in a supine position or head down (if
not contraindicated) to decrease the risk of air entering through an intact skin-to-vein tract
which may result in an air embolism
Ensure all infusions are turned off and CVC lumens are clamped shut
Decontaminate hands
Prepare equipment, dressing trolley, dressing pack, stitch cutter, chlorhexidine 2% in
alcohol solution or swabs, gauze, transparent dressing. Sterile scissors and container if
catheter tip is for culture
Seek assistance of another staff member if required
Remove dressing from the catheter exit site
Cleanse the site with chlorhexidine in alcohol swabs or solution
Remove sutures if in place while your assistant is holding the catheter to prevent
accidental dislodgement
Place sterile gauze over the entry site and apply light pressure, gently withdraw the
catheter and place on sterile field
Apply firm pressure over the puncture site for at least 2 minutes until haemostasis is
achieved
Apply transparent air tight dressing ensuring a good seal is achieved and reposition patient
Check that the catheter is intact and tip is present before disposing of it in clinical waste
bin
Document in nursing notes
(British Journal of Nursing 2010)
References
Canterbury District Health Board (2016) Central Venous Access Resource Book, accessed September 2016
Centre of Disease Control (2011) Guidelines for the prevention of intravascular catheter-related infections,
accessed July 2016
Dougherty, L. (2006) Central Venous Access Devices: Care and Management, Blackwell publishing, Oxford.
Health Protection Surveillance Centre (2009) Prevention of Intravascular Catheter-related Infection in
Ireland: A strategy for the control of Antimicrobial resistance in Ireland, HSE, Dublin 1.
Infusion Therapy Standards of Practice Reviewers (2016) Infusion Therapy Standards of Practice, Journal of
Infusion Nursing, 39 (1S), 1-141.
Hatler, C., Buckwald, L., Salas-Allison, Z. and Murphy-Taylor, C. (2009) Evaluating central venous catheter
care in a paediatric intensive care unit, American Journal of Critical Care, 18, (6), 514-520.
Kelly, L., Green, A. and Hainey, K. (2015) Implementing a new teaching and learning strategy for CVAD care,
British Journal of Nursing, 24 (8), 4-12.
Scales, K. (2010) Central venous access devices, Part 1; devices for acute care, British Journal of Nursing, 19,
(2), 88-92.
Scales, K. (2010) Central venous access devices, Part 2: for intermediate and long term use, 19,(5), 20-24.
OLCHC (2013) Guidelines on the care of a central venous access device (CVAD) for clinical staff, OLCHC.
Assessment – Central Venous Access Device knowledge
1) List 3 indications for the insertion of a CVC?
2) State 3 types of CVADs?
3) List 3 complications of CVAD insertion?
4) What test needs to be carried out prior to the use of a newly inserted CVAD and explain the
reason why?
5) What size syringe should be used when accessing CVADs and why?
6) Describe the term ‘push – pause or stop-start flushing’ and why is it recommended when
flushing CVADs?
7) Explain what is meant by ‘positive pressure flushing technique’?
8)
State how frequently the ‘needle free device’ requires changing
9) What is the most common cause of CRBSI?
10) How frequently should the CVAD dressing be changed?
11) How should a patient be positioned prior to the removal of a CVAD?
Signed by_______________________________NMBI__________________Date___________________
Reviewed / Corrected by_________________________NMBI__________________Date____________
References
Canterbury District Health Board (2016) Central Venous Access Resource Book, accessed September 2016
Centre of Disease Control (2011) Guidelines for the prevention of intravascular catheter-related infections,
accessed July 2016
Dougherty, L. (2006) Central Venous Access Devices: Care and Management, Blackwell publishing, Oxford.
Health Protection Surveillance Centre (2009) Prevention of Intravascular Catheter-related Infection in
Ireland: A strategy for the control of Antimicrobial resistance in Ireland, HSE, Dublin 1.
Infusion Therapy Standards of Practice Reviewers (2016) Infusion Therapy Standards of Practice, Journal of
Infusion Nursing, 39 (1S), 1-141.
Hatler, C., Buckwald, L., Salas-Allison, Z. and Murphy-Taylor, C. (2009) Evaluating central venous catheter
care in a paediatric intensive care unit, American Journal of Critical Care, 18, (6), 514-520.
Kelly, L., Green, A. and Hainey, K. (2015) Implementing a new teaching and learning strategy for CVAD care,
British Journal of Nursing, 24 (8), 4-12.
Scales, K. (2010) Central venous access devices, Part 1; devices for acute care, British Journal of Nursing, 19,
(2), 88-92.
Scales, K. (2010) Central venous access devices, Part 2: for intermediate and long term use, 19,(5), 20-24.
OLCHC (2013) Guidelines on the care of a central venous access device (CVAD) for clinical staff, OLCHC.