| Introduction |
1 |
| I. Objectives |
3 |
| II. Vascular access devices (VADs) |
3 |
| A. Overview of VADs |
3 |
| B. Peripheral IV catheters |
20 |
| C. SC infusion devices |
30 |
| D. Midline catheters |
34 |
| E. PICCs |
37 |
| F. Central venous lines (nontunneled) |
41 |
| G. Tunneled central venous catheters (CVCs) |
43 |
| H. Implanted venous ports |
45 |
| I. Apheresis/hemodialysis catheters |
48 |
| III. Arterial access devices |
49 |
| A. Description and types of devices |
49 |
| B. Advantages and disadvantages of arterial therapy |
49 |
| C. Patient selection criteria |
50 |
| D. Patient setting |
50 |
| E. Insertion procedures and perfusion checks |
51 |
| F. Postoperative care |
52 |
| G. Removal |
52 |
| H. Drug delivery with arterial access |
53 |
| I. Access, flushing, and dressing |
53 |
| J. General practice issues |
54 |
| K. Complications |
54 |
| L. Education and documentation |
54 |
| IV. Intraventricular access devices |
54 |
| A. Description of devices |
54 |
| B. Advantages and disadvantages |
54 |
| C. Patient selection criteria |
54 |
| D. Insertion procedures |
55 |
| E. Postoperative care |
55 |
| F. Removal of device |
56 |
| G. Access, dressing, and flushing procedures |
56 |
| H. Complications |
57 |
| I. Patient education |
58 |
| J. Education and documentation |
58 |
| V. Epidural and intrathecal access devices |
58 |
| A. Purpose of epidural and intrathecal access |
58 |
| B. Description of access devices |
58 |
| C. Placement |
59 |
| D. Advantages and disadvantages of epidural/intrathecal access devices |
60 |
| E. Patient selection for epidural and intrathecal access devices |
60 |
| F. Nursing management |
60 |
| G. Complications |
62 |
| H. Education and documentation |
64 |
| VI. Intraperitoneal catheters |
64 |
| A. Description of device |
64 |
| B. External tunneled catheters |
64 |
| C. Implanted SC ports |
65 |
| D. Advantages and disadvantages of catheter selection |
65 |
| E. Patient selection criteria |
65 |
| F. Insertion procedures |
67 |
| G. Postoperative care |
67 |
| H. Removal of devices |
68 |
| I. Maintenance care |
68 |
| J. General practice issues |
69 |
| K. Complications |
70 |
| L. Education and documentation |
70 |
| VII. Implanted pumps |
73 |
| A. Device description |
73 |
| B. Advantages of continuous infusion therapy |
74 |
| C. Patient selection and treatment criteria |
74 |
| D. Patient setting |
75 |
| E. Insertion procedures and perfusion checks |
75 |
| F. Postoperative care |
75 |
| G. Removal |
75 |
| H. Patient education |
75 |
| I. General practice issues |
75 |
| J. Access procedures |
77 |
| K. Complications |
79 |
| L. Education and Documentation |
79 |
| VIII. Education and documentation issues for access devices |
80 |
| A. Education |
80 |
| B. Documentation |
80 |
| IX. Controversial issues |
81 |
| A. Dressing types |
81 |
| B. Cleansing agents |
98 |
| C. Flushing agents |
98 |
| D. VAD without blood return |
99 |
| E. Catheter occlusion |
99 |
| F. Infection/infection control |
100 |
| G. Removal of CVCs |
101 |
| H. Blood sampling from CVCs |
102 |
| I. Power injection of contrast media |
102 |
| J. Controversial issues related to nursing practice |
102 |
| References |
103 |
| Appendices |
119 |
| Appendix 1. Access Device Resource |
119 |
| Appendix 2. Peripheral IV Practicum |
120 |
| Appendix 3. Subcutaneous Infusion Practicum |
121 |
| Appendix 4. Long-Term Venous Catheter Practicum |
122 |
| Appendix 5. Short-Term Nontunneled Venous Catheter Practicum |
123 |
| Appendix 6. Implanted Port Practicum |
125 |
| Appendix 7. Arterial Catheter Practicum |
127 |
| Appendix 8. Intraventricular Reservoir Practicum |
128 |
| Appendix 9. Epidural/Intrathecal Devices Practicum |
129 |
| Appendix 10. Intraperitoneal Catheter Practicum |
130 |
| Appendix 11. Implanted Pump Practicum |
132 |
| Index |
133 |