pvad
New Updated 10/1/2019
INDICATIONS:
- Acute status patients (BHC with CCERC)
- Cardiopulmonary arrest - Medical and Trauma
- Medications - All medications approved for venous administration
CONTRAINDICATIONS:
- Obvious signs of infection at the site
- Cracked or damaged device access point
PROCEDURES:
External Access Port Device:
1. Discontinue any current IV solution
2. Use clean gloves
3. Prepare 10 mL syringe, IV administration set and IV solution
4. Prep injection port with alcohol swab. If clamped, unclamp catheter
5. Slowly inject 5 mL NS into port. If resistance is met, re-clamp catheter and do not use
6. If no resistance is met, inject remaining 5 ml NS into catheter
Medication Administration:
1. Inject IV dose of medication through PVAD port
2. Flush with 10 mL normal saline injected with syringe
3. When complete, clean port and re-clamp PVAD
IV Infusion with NS or 10% Dextrose Solution:
1. Insert IV tubing into PVAD port (needleless)
2. 16-14 gauge needle for non-needleless port
3. Secure tubing with tape
4. When complete, clean port and re-clamp PVAD
Subcutaneous Hemodialysis Shunts:
A surgically created arteriovenous connection used for hemodialysis. A subcutaneous fistula may be accessed in critical patients requiring immediate medication administration in life-threatening situations only.
1. Discontinue any current IV solution
2. Use clean gloves
3. Clean skin area over fistula with alcohol or chlorohexdine solution
4. Feel over fistula for thrill (feeling of blood flow)
5. Identify side of fistula with weakest thrill
6. Using empty 10 mL syringe, aspirate site for injection/infusion to obtain about 3 mL of blood return
7. If no blood return, do not use the fistula, cover site with gauze and tape
Medication Administration:
1. Inject IV dose of medication through identified site area (venous side)
2. Flush with 10 mL normal saline injected with syringe
3. When complete, clean the site and place pressure dressing with gauze and tape
IV Infusion with NS or 10% Dextrose Solution:
1. Insert 16 gauge IV catheter into identified site area (venous side)
2. Connect IV tubing and infuse IV fluid
3. Secure tubing with tape
4. When complete, clean the site and place pressure dressing with gauze and tape
CAUTIONS:
1. Do not allow air bubbles into system, may cause air embolism
2. Excessive bleeding can occur around hemodialysis fistula during or acfter access, use point direct pressure to control bleeding (avoid tourniquet)
3. Use 10 mL syringes to avoid excess pressures in PVAD line
DOCUMENTATION:
1. Document all access attempts, site, and time accessed or attempted for access
2. Notify receiving hospital staff of PVAD use and site (even if not successful)
Types of Catheters:
External Silastic Indwelling Catheter/Devices:
Broviac, Hickman and others:
Silicone tube inserted in the chest; Heparinized and protected by injectable cap.
Midline catheter:
Enters the arm via vein near the AC area. Commonly used for long-term antibiotic admin.
PICC Line:
Peripherally inserted central catheter inserted into right atrium via peripheral arm vein.
Hemodialysis catheter:
- Large tube inserted into distal superior vena cava via the subclavian vein. Usually a higher concentration of heparin is in the tube, which must be aspirated prior to use.
- Internal Subcutaneous Infusion Ports: NOT approved for access by prehospital personnel.
- A pre-existing vascular access device (PVAD): is an indwelling catheter/device placed into one of the central veins, to provide vascular access for patients requiring long term intravenous therapy or hemodialysis.