Catheters, venous

Monitoring the patient in shock requires vigilance on the part of the nurse The patient s heart rate, blood pressure, and ECG are monitored continuously. The urinary output is measured often (usually hourly), and an accurate intake and output is taken. Monitoring of central venous pressure via a central venous catheter will provide an estimation of the patient s fluid status. Sometimes additional hemodynamic monitoring is necessary with a pulmonary artery catheter. The use of a pulmonary artery catheter allows the nurse to monitor a number of parameters, such as cardiac output and peripheral vascular resistance The nurse adjusts therapy according to the primary health care provider s instructions. 

TPN may be administered through a peripheral vein or through a central venous catheter. Peripheral TPN is used for patients requiring parenteral nutrition for relatively short periods of time (no more than 5-14 days) and when the central venous route is not possible or necessary. Peripheral TPN is used when the patient s caloric needs are minimal and can be partially met by normal... 

Vascular inujury Major orthopedic surgery (e.g., knee and hip replacement) Trauma (esp. fractures of the pelvis, hip, or leg) Indwelling venous catheters... 

Thrombosis associated with hemodialysis most commonly occurs in patients with venous catheter access for dialysis and is a common cause of catheter failure. However, thrombosis can occur in synthetic grafts and less frequently in AV fistulas. 

Blood cultures should be obtained for any patient receiving hemodialysis who develops a fever. Nonpharmacologic management of infections involves preventive measures with sterile technique, proper disinfection, and minimizing the use and duration of venous catheters for hemodialysis access. 

Acute P. falciparum malaria resistant to chloroquine should be treated with intravenous quinidine via central venous catheter and fluid status and the electrocardiogram (ECG) should be monitored closely. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Candida species are the most common opportunistic fungal pathogens encountered in hospitals, ranking as the third to fourth most common cause of nosocomial bloodstream infections in United States Hospitals.18 The incidence of nosocomial candidiasis has increased steadily since the early 1980s, with the widespread use of central venous catheters, broad-spectrum antimicrobials, and other advancements in the supportive care... 

A 43-year-old male in the surgical ICU after exploratory laparotomy following a motor vehicle accident develops fever that is unresponsive to broad-spectrum antibacterial therapy (piperacillin-tazobactam 3.75 g every 6 hours, gentamicin 120 mg every 8 hours, and vancomycin 1 g every 12 hours). The patient has a central venous catheter and a Foley catheter. Blood cultures are negative at the time, but the patient has yeast growing in the sputum and urine. Laboratory studies reveal a white blood cell count of 11,300 cells/mm3 (11.3 x 109/L). 

Because of the need for repeated venous access, a central venous catheter or infusion port is placed prior to starting treatment. These devices are useful not only for delivery of chemotherapy but also to support patients during periods of myelosuppression. Infection and bleeding complications are the primary cause of mortality in patients with leukemia. 

Central venous catheters should be placed for vesicant administration whenever possible, especially in high-risk patients. 

Central PN refers to the administration of PN via a large central vein, and the catheter tip must be positioned in the vena cava. Central PN allows the infusion of a highly concentrated, hypertonic nutrient admixture. The typical osmolarity of a central PN admixture is about 1500 to 2000 mOsm/L. Central veins have much higher blood flow, and the PN admixture is diluted rapidly on infusion, so phlebitis is usually not a concern. Patients who require PN administration for longer periods of time (greater than 7 days) should receive central PN. One limitation of central PN is the need for placement of a central venous catheter and an x-ray to confirm placement of the catheter tip. Central venous catheter placement may be associated with complications, including pneumothorax, arterial injury, air embolus, venous thrombosis, infection, chylothorax, and brachial plexus injury.1,20... 

Patients receiving central PN are at increased risk of developing infectious complications caused by bacterial and fungal pathogens.1,50 Infections maybe related to placement of a central venous catheter, contamination of a central venous catheter or... 

Mechanical complications of PN are related to catheter placement and the system and equipment used to administer PN. A central venous catheter must be placed by a trained professional, and risks associated with placement include pneumothorax, arterial puncture, bleeding, hematoma formation, venous thrombosis, and air embolism.1,20 Over time, the catheter may require replacement. Problems with the equipment include malfunctions of the infusion pump, intravenous tubing sets, and filters. 

BS Bowel sounds breath sounds blood sugar CVC Central venous catheter... 

Central venous catheter access results in faster and higher peak drug concentrations than peripheral venous administration, but central line access is not needed in most resuscitation attempts. However, if a central line is already present, it should be the access site of choice. If IV access (either central or peripheral) has not been established, a large peripheral venous catheter should be inserted. Intraosseous (IO) administration is the preferred alternative if IV administration cannot be achieved. 

S. aureus has become more prevalent as a cause of endocarditis because of increased IV drug abuse, frequent use of peripheral and central venous catheters, and valve-replacement surgery. Coagulase-negative staphylococci (CNST, usually S. epidermidis) are prominent causes of PVE. 

In patients with an intact immune system, removal of all existing central venous catheters should be considered. 

Candida albicans, C. tropicalis, C parapsilosis and resolution of signs and symptoms of infection Remove existing central venous catheters when feasible, plus Amphotericin B IV 0.6 mg/k day or Fluconazole IV/po 6 mg/kg/day or An echinocandin or Amphotericin B IV 0.7 mg/kg/day plus fluconazole IV/po 800 mg/day Patients intolerant or refractory to other therapf Amphotericin B lipid complex IV 5 m k day Liposomal amphotericin B IV 3-5 mg/kg/day Amphotericin B colloid dispersion IV 2-6 mg/k day (continued)... 

Remove existing central venous catheters when feasible, plus Amphotericin B IV 0.7-1 m k day (total dosages 0.5-1 g)... 

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

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