A central venous access device (CVAD) is a catheter inserted into the central venous system to deliver fluids, medications, blood products, and nutrition either short-term or long-term. CVADs are commonly used when peripheral access is limited or for ongoing home therapy. There are several types of CVADs including tunneled catheters, nontunneled catheters, PICCs, and implanted ports. Proper care and maintenance of CVADs includes regular dressing changes using aseptic technique, flushing the catheter with saline to maintain patency, and locking catheters with saline or low-dose heparin between uses.

1. Central Venous Access Device
Photo: Community Nurses Lounge.comContent Revised as of November 26, 2013

2. What is CVAD?
• A central venous access
device (CVAD) is a
catheter that is inserted
into the central venous
system with the internal
tip sitting within the
superior/inferior vena
cava or right atrium (Royal
College of Nursing (RCN)
2010; Doughtery and Lister
2008). Photo: Tamara Joy Fowler

3. What is CVAD?

4. Why CVAD?
Catheters can be used either short- or long-term for the infusion of:
• Parenteral Nutrition
• Chemotherapy or other vesicant or irritating solutions
• Blood and blood products
• Antibiotics
• Medication/solutions in patients with limited peripheral access
• Therapy that is ongoing or continued at home

8. Types of Central Venous Catheters
Photo: Genentech Cath Matters USA

9. Types of Central Venous Catheters
Photo: Genentech Cath Matters USA

10. Types of Central Venous Catheters
Photo: Genentech Cath Matters USA

11. Types of Central Venous Catheters
Photo: Genentech Cath Matters USA

12. Site Choices: Adult Patients

13. Site Choices: Pediatric Patients

14. Tunneled Catheters

15. Nontunneled Site

16. P.I.C.C. Line
Photo: Genentech Sean Ternan

17. Implanted Port

18. Advantages and Disadvantages

19. Advantages and Disadvantages

20. Advantages and Disadvantages

21. Advantages and Disadvantages

22. Care and Maintenance
• Assessment:
- Insertion Site
- Catheter Tract
- Adjacent Skin

23. Care and Maintenance
• Site Care:
- Skin Disinfectant
- Clean, dry, and
occlusive dressings

24. DRESSING
Gauze or Transparent Semi-Permeable?

25. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• BEFORE PROCEDURE
1. Wash Hands
2. Assemble equipment
3. Don sterile gloves and other PPE
4. Use aseptic technique and observe standard
precautions throughout the procedure.

26. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• DURING PROCEDURE
1. Remove dressing from VAD insertion site.
2. Inspect Site and catheter
3. Disinfect the catheter-skin junction using
antiseptic solution
4. Dress access site

27. PROCEDURE FOR SITE CARE AND DRESSING CHANGE
(Infusion Nurses Society: Norwood, Mass 2006)
• POST PROCEDURE
1. Discard used supplies
2. Remove gloves
3. Wash hands
4. Label new dressing
1. Document

28. CATHETER FLUSHING
Vascular Access Devices
shall be flushed at
established intervals to
promote and maintain
patency and prevent the
mixing of incompatible
medications and
solutions.
(Infusion Nursing Standards of Practice:INS, 2006)

29. How often?

30. CATHETER FLUSHING
 The flushing volume should at least be twice the internal volume of
the CVAD and injection cap.
 Preservative-free 0.9% NaCl flushing solutions shuld be used to
ensure and maintain patency of CVADs at established intervals.
 0.9% NaCl with preservatives should not be administered to
neonates and pediatric patients; if used with adult patients, the
volume should not exceed more than 30mL per day
 Flushing with a heparin solution should occur to ensure and
maintain patency of CVADs at established intervals.

31. CATHETER LOCKING
 For intermittently used CVADs, (INS) 2008 recommends”locking”
with owconcentraion heparin as follows:
CVAD Heparin Lock
Recommendations
PICC and Nontunneled Daily with 5mL (10units/mL)
Tunneled Twice Weekly with 5mL
(10units/mL)
Implanted Port Monthly with 3 to 5mL
(100units/mL)

33. Heparin or Preservative-free 0.9 NaCl?
The move to use preservative-free 0.9%NaCl results from
concern over heparin supporting microbial growth, periodic
heparin supply Issues, And use of positive/neutral Pressure
injection caps valves.

34. Trends in CVAD

35. Trends in CVAD

36. Trends in CVAD