Acceso Venoso

02 ED CVC Quick Guide CoverF

8/28/02

3:10 PM

Page 1

QUICK GUIDE TO

Central Venous Access

Edwards Lifesciences LLC · One Edwards Way · Irvine, CA USA 92614
Phone: 949.250.2500 · 800.424.3278 · Fax: 949.250.2275 · www.edwards.com
Edwards Lifesciences S.A. · Ch. du Glapin 6 · 1162 Saint-Prex · Switzerland
Phone 41.21.823.4300
Edwards Lifesciences (Canada) Inc. · 1290 CentralPkwy West, Suite 300
Mississauga, Ontario · Canada L5C 4R3 · Phone 905.566.4220 · 800.268.3993
Edwards Lifesciences Japan · 2-8 Rokubancho
Chiyoda-ku, Tokyo 102-0085 · Japan · Phone 81.3.5213.5700

QUICK GUIDE TO

Central Venous
Access

02 ED CVC Quick Guide CoverF

7/22/05

11:37 AM

Edwards Lifesciences, Edwards, the stylized E logo, Advanced Venous
Access (AVA), AVA 3Xi, AVA HF,AMC THROMBOSHIELD and Vantex
are trademarks of Edwards Lifesciences Corporation. CCOmbo,
Intro-Flex, Multi-Med, and Swan-Ganz are trademarks of Edwards
Lifesciences Corporation and are registered in the US Patent and
Trademark Office.
Interlink is a trademark of Baxter International Inc., registered in the
U.S. Patent and Trademark Office. Oligon is a trademark of
Implemed, Inc.
© 2002Edwards Lifesciences LLC. All rights reserved. 1098-6/99-CC

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QUICK GUIDE TO

Central Venous
Access

EDITORS

Marsha Halfman, RN, MSN
Critical Care Consultant
Scottsdale, AZ

Sandra Reiner, RN, BSN, CIC
Infection Control Coordinator
Northwestern Memorial Hospital
Chicago, IL

Table of Contents
OVERVIEW

TA B L E O F C O N T E N T S

Historical PerspectiveIndications for Use
Types of Central Venous Access Devices
Catheter Specifics
Polyurethane
Number of Lumens
Flow Characteristics
Length
Coatings
Other Considerations
CVC Port Designation
Port Color Designation
Introducers as a Central Line
French Catheter Size Conversion

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2
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3
3
4
4
5
6
6
6
7

I N S E RT I O N A N D R E M O VA L

Insertion Sites
Sites: Advantagesand Disadvantages
Seldinger Technique
Patient Preparation
Patient Position
The Circulation System
Clinical Considerations: Insertion
Insertion Complications
Air Embolism
Arterial Puncture
Arrhythmias
Pneumothorax
Malpositioned Catheters
Cardiac Tamponade
Clinical Responsibilities: Complications
Delayed Complications
Thrombosis
Catheter Occlusion
Infection
Infection: DiagnosisClinical Responsibilities: Delayed Complications
Catheter Exchange
Clinical Responsibilities: Catheter Exchange

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10
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15
17
18
20
21
21
22
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23
24
25
25
26
27
30
31
31
33

CVC Removal
Clinical Considerations: Catheter Removal

33
34

SITE MAINTENANCE

Site Care
Site Inspection
Site Cleansing
Dressings
Other Considerations
Clinical Considerations:Dressing Change

36
36
37
39
40
41

NEEDLESTICK INJURIES

Hepatitis B
Hepatitis C
HIV
Safe Needle/Needleless Systems

42
42
TA B L E O F C O N T E N T S

42
43

BLOOD SAMPLING

Blood Conservation
Draw Methods
Discard Volume
CVC Catheter Volume
Chemistry Studies
Hematology Studies
Blood Cultures
Coagulation Studies
Clinical Considerations: Blood Sampling
NormalReference Ranges for Laboratory Blood Tests

45
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48
48
49
49
50
51
53

FLUSHING (INTERMITTENT)

Positive Pressure Flushing
Saline vs. Heparin
Concentration
Flush Volume
Clinical Considerations: Flushing

54
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55
56
56

Table of Contents continued on page iii

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INFUSION THERAPY

TA B L E O F C O N T E N T S

Fluid Administration
IV Delivery System
In-LineFilters
Stopcocks
Piggyback Systems
Medication Administration
Drug Incompatibility
Other Considerations
Nitroglycerin Administration
Blood Administration
Administration of TPN
Clinical Considerations: IV Administration
Frequently Used Drugs in Critical Care

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MONITORING CENTRAL VENOUS PRESSURE

Fluid Challenge Guideline...