Академический Документы
Профессиональный Документы
Культура Документы
AVA has prepared this guide primarily for the information of patients and as a reference for practitioners and other interested parties. AVA has designed and limited the Guide to provide accurate and authoritative information about Central Vascular Access Devices (CVADs). AVA distributes this Guide with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the Guide. The reader should consult with a medical professional if medical service is required.
11441 South State Street I Suite A, #113 I Draper, UT 84020 I 888-576-2826, 801-576-1824, Fax 801-553-9137 I www.avainfo.org I e-mail: info@avainfo.org
Page 2
Like you, most people have many questions about how CVADs work, what it is like to live with one, and how to care for it. Here are questions you might want to ask your doctor or nurse: 1. What kinds of CVADs are available to me? 2. What kind of CVAD is best for me? Why? 3. How does the CVAD get put into my body? 4. When do I need to have the CVAD changed or replaced? Can I pull the CVAD out accidentally? 5. Where on my body is the CVAD placed? 6. Will people be able to see the CVAD? 7. Will it hurt to use a CVAD? 8. How long will the CVAD last? 9. Under what circumstances do I need to have the CVAD changed or replaced? 10. How do I take care of the CVAD? 11. How often do people have problems with CVADs? 12. How will I know if something is wrong with the CVAD? 13. What are the most common problems with CVADs? 14. What should I do if I have a problem with my CVAD? 15. Can I get the CVAD wet (showering, bathing, swimming)? 16. Can I work or play sports with my CVAD? 17. Is it safe to have sexual relations while I have a CVAD? 18. How much will the CVAD cost?
Page 3
Page 4
A Non-Tunneled Central Catheter is most often used for short-term therapies that might last only a few weeks.
Page 5
A Tunneled Catheter
A Tunneled Catheter is a long-term CVAD with part of the catheter placed under the skin (tunneled). Sometimes these are known as Hickman or Broviac catheters, as these are some popular brands. Some Tunneled Catheters also have a cuff along the catheter that helps anchor the catheter to the tissue under the skin. It also helps serve as a barrier to infection. Catheters are tunneled for a few reasons. First, it helps anchor the catheter; it is more difficult to pull the CVAD out if there is a segment running under the skin. Second, tunneling makes the CVADs exit site separate from the vessel entrance site; this may reduce the risk of infection. Tunneled Catheters are very durable and can last for years with proper care. A Tunneled Catheter is connected directly to IV tubing for the delivery of fluids or medicine, which means no needle stick is required for the catheter to be used. These catheters are good for people who require many infusions at the same time. One disadvantage of a Tunneled Catheter is that a segment of the CVAD is outside the body. Some people dont like this because this portion of the catheter needs to be covered by a dressing and flushed to keep it working properly. Tunneled Catheters come in various types and sizes. The type of catheter you have will depend on your individual needs. For example, patients using a Tunneled Catheter for dialysis require a different type of catheter than patients receiving antibiotics, TPN (for nutrition) or chemotherapy. Tunneled Catheters are removed by your doctor or a medical professional specifically trained in the procedure. Removal is not typically done at home, but rather in a hospital or doctors office. Your doctor will most likely discuss the removal details with you prior to the procedure.
Tunneled catheters are very durable and can last for years with proper care.
Page 6
A Port
A port is a type of CVAD that is placed totally under the skin. A port is made up of two parts: the catheter and a portal body to which it is attached.The catheter sits in the vein. The body of the port is made of a plastic or metal disc with a rubbery center, or septum, that is the entry into a reservoir. The port is used by sticking a special needle (called a Huber needle) through the skin, into the rubber center, and into the reservoir. Because the port is under the skin, placing a port is a slightly longer procedure than placing other types of CVADs. Your healthcare team will explain the insertion procedure. It may be different than what we describe here. Some people like ports because the entire system is under the skin. So, when you do not need therapy, the only care it needs is to have it flushed once a month. You can swim and carry on your usual activities. There will be a small bump visible under the skin over the port. People who are active sometimes prefer ports because there are almost no activity restrictions when the port does not have a needle in it. A disadvantage of ports is that the placement and removal procedures are slightly more involved when compared to other CVADs. Also, a needle stick through the skin is needed to gain access into the port. Some people dont like the idea of another needle stick. You may ask your doctor about a prescription for numbing cream that can be used to make this needle stick more comfortable. Ports are very durable and can last for years. They are available in single and double lumen designs. They also come in different sizes, and your doctor will choose a size to fit your body and therapy needs.
Page 7
Blockages in a CVAD
A blockage, or occlusion, is a problem that can occur with CVADs. A blockage can mean that you cannot flush, infuse medicines or draw blood from the CVAD. This may mean that the medicines are not being delivered into the proper place. There are common reasons for CVADs to become blocked. Contact your doctor or nurse, who can help overcome most of these problems. Here are a few common reasons for blockages: Blood clots in the CVAD or in the blood vessel around your CVAD can cause blockage. Clots can plug up the catheter, making infusions difficult. Sometimes you can infuse your medicines, but are unable to get blood out. This may be caused by a fibrin sheath, which is tissue your body may deposit on the catheter. Both of these problems can be treated with clotbusting drugs given through the CVAD, which help dissolve the clot or sheath. Sometimes, the catheter may need replacement or other methods need to be used to restore catheter function (including angioplasty, or ballooning). Mechanical blockages, or malpositions, can occur when a catheter is in the wrong place in a blood vessel, is kinked or pinched, or has broken. This could also happen if your CVAD has accidentally come out part of the way or been pushed in too far. Sometimes the catheter can be repositioned to restore function. Residue or precipitate build-up inside the CVAD is another cause of blockage. This can occur if medications interact with one another, if they leave behind a residue, or if your CVAD is not flushed properly. Sometimes solutions can be injected into your CVAD to dissolve the residue.
Page 8
Infection
Infections are caused by germs getting in or around a CVAD and can become a serious problem if not treated promptly. Make sure to check daily for: Redness, swelling, warmth, tenderness or drainage where the CVAD enters or exits your body. You may have a local infection. Fever, chills, vomiting, diarrhea, fatigue, weakness and loss of appetite. These can be signs that there is an infection in your bloodstream. If any of these occur, you should contact your doctor or nurse immediately.
Phlebitis
Inflammation of the vein, called phlebitis, can occur if the tissue or blood vessel near the CVAD gets irritated or damaged. This can be a response to a foreign body in the CVAD or to the medicine or fluids being given through the CVAD. Notify your doctor or nurse if you have redness, swelling, pain, hardness or warmth near the CVAD.
Page 9
If your catheter does break, you may see that your dressing is wet, that fluid leaks out when you flush or that some blood is leaking out of the catheter. If the catheter is broken, immediately place a clamp above the break, close to your skin (after the catheter is placed, ask your nurse or doctor for an extra clamp to use in an emergency), and call your nurse or doctor. Some catheters can be repaired, while others may need to be removed and replaced.
Page 10
Conclusion
CVADs provide the simplest, quickest, and most efficient way of receiving important medications and other fluids during your illness. Because problems may occur with your CVAD, it is critical for you to know the signs of a complication and alert your caregiver. This guide was developed by AVA with support from Genentech, Inc.
Glossary of Terms
Angioplasty when a doctor inflates a balloon device inside a blood vessel to flatten any plaque that blocks it and causes the blood vessel to become narrowed Catheter a flexible, usually rubber or soft plastic tube placed into the body for removing or giving fluids for diagnosis or treatment purposes Cuff outside part of the catheter that surrounds the entrance site Entrance site the place where a catheter is inserted into the body Exit site the place where a catheter comes out from the body External segment part of the catheter that is outside of the body Fibrin sheath tissue your body may deposit on the catheter Flush wash out with liquid Lumen a cavity, opening or channel inside the catheter Occlusion blockage or closing-off of a blood vessel or passageway in the body, as in a clot stopping up a blood vessel Peripheral to the outside surface, or area away from the center of an organ or of the body Therapy a procedure designed to treat disease, illness or disability Tunnel a passageway under the skin VAD - a term that describes many types of catheters that are placed in a vein or artery in your body