Central Venous Access Device

CVAD RELATED COMPLICATIONS CVAD RELATED COMPLICATIONS 10Department 10 CVAD RELATED COMPLICATIONS CENTRAL VENOUS ACCESS DEVICE RELATED INFECTION Name of the Student Name of the University Author note CVAD or Central Venous Access Device is a system, which is inserted in the veins of the patient to deliver blood stream to the patient. He was admitted to the emergency department of the hospital and after his primary health check-up, doctor inserted three central venous

Running head: CVAD RELATED COMPLICATIONS
CENTRAL VENOUS ACCESS DEVICE RELATED INFECTION
Name of the Student
Name of the University
Author note

1CVAD RELATED COMPLICATIONS
CVAD or Central Venous Access Device is a system, which is inserted in the veins of the
patient to deliver blood stream to the patient. It is utilized in different medical interventions for
the insertion of fluids, resuscitation or blood different hyper-osmolar drugs to the bloodstream
(Moureau et al. 2013). This assignment is going to discuss about Jim Karas (59), who was
admitted to hospital after being unresponsive and unable to breathe out. He was admitted to the
emergency department of the hospital and after his primary health check-up, doctor inserted
three central venous catheter into his right subclavian veins using surgical aseptic non touch
technique (ANTT). This assignment will be discussing the complications of Jim Karas which is
CVAD associated bloodstream infection and the preventive strategy of it, prevention and
management of occlusion and local skin irritation because of these medical interventions. These
complications, its types, infection process, prevention and management process will be discussed
with the help of literatures and the critical discussion will be presented below.
The moment when Jim was found unresponsive, doctors were able to detect a faint
cardiac pulse and therefore they inserted an oropharyngeal airway intravenous cannula and
provided him with 100 percent oxygen ventilation. He was still unresponsive to the treatments
and therefore the doctor Jaram incubated him for mechanical incubation. Finally, the doctor
inserted three central venous catheters (CVC) in the veins of Jim to improve his condition
However, one day later, a red swollen infection was found near the insertion site of CVC and the
infection was detected as the Central Line Associated Bloodstream Infection (CLABSI) (Miller
and Maragakis 2012). It is a common factor in the long-term use of catheter in the blood stream.
There can be several reasons due to which, the CVAD related infection could occur in patients.
Few of such reasons are ruptured catheter, dislocation of the catheter inside the vein, chylothorax
and paravasation (Yeoh et al. 2013). In the case study, Jim was also suffering from infection and

2CVAD RELATED COMPLICATIONS
his swollen site of catheter injection was indicating towards the fact that he was being affected
with the CVAD related infection.
Preventive measures
There are several preventive measures for the protection from this infection. The primary
and most effective one is application of 2 percent chlorhexidine based alcohol solution and
continuous skin care after the injection of the catheters in the blood stream, cleaning the injection
hub or the connector will be helpful in preventing such disorder in the injection site (Department
of Health and Human Services USA, 2018). The ANTT technique or the aseptic not touch
technique was used as the preventive measure for Jim, which is effective in preventing the
bloodstream related infection after injecting the CVC into his body. The doctors continuously
used hand washes and sanitizers to prevent the normal micro flora of the hand to be colonized in
the wounds of Jim. Another therapy that can be used in the infection of CVAD is continuous
dressing of the site of injection (Department of Health and Human Services USA, 2018). If Jim
was provided with continuous dressing of his CVAD insertion site, dressing around the skin
tunnel until the wound has healed. Further, after the healing of this site, dressing would be done
in the injection port pocket (Hentrich et al. 2014). According to the guidelines from the CDC of
USA, the dressing should be semi-permeable and it should be replaced every time it becomes
damp or loosened. Two percent chlorhexidine solurton should be used for the cleansing purpose
of Jim and this strategy is effective in preventing primary BSIs (Department of Health and
Human Services USA, 2018). These are the ways the nursing staff of the organization should be
used to provide care to Jim in his CVAD related infection. These researches are based on the
level I of the level of evidence and within this, randomized control trial or RCTs and meta-

3CVAD RELATED COMPLICATIONS
analysis studies are included. The preventive measured that have been used for Jim are
depending on the CDC department of the United States of America. Therefore, it was used for
Jim to prevent his CVC related bloodstream infections (Lai et al. 2013).
The second complication that Jim suffered during the treatment in the healthcare system
after his unresponsiveness was occlusion. According to the data, 14 to 36 percent of patients
generally suffers from the catheter related occlusion and the time taken for the occurrence of the
occlusion is 1 to 2 year after the injection of catheters (Oliveira et al. 2012). The occlusion can
be partial in which, the blood is not been able to aspirate but the catheter infusion is possible
(Zhang et al. 2014). However, due to occlusion, neither aspiration nor the infusion is possible
(Linnemann 2014). The primary reason for occlusion is the usage of low quality catheters for the
intervention (Oliveira et al. 2012). The secondary reason can be the several mechanical issues,
emerging after the application of the catheter in the bloodstream (Braithwaite et al. 2014).
Finally, there can be reaction between the provided drugs, making the flow of liquid through the
veins sluggish. Further, if the pH of the infusion is too alkaline or acidic in nature precipitation
can also be occurred in the blood stream creating an occluded condition. Even high amount of
lipid residues in the nutrition can cause the occlusion condition (Zhang et al. 2014). According to
the Bolton (2013), intraluminal clots are one of the reasons due to which, catheter occlusion
occurs and according to the statistics, 5 to 26 percent of the catheter occlusions are resulted from
it. There are several management strategies of occlusion due to catheter or physiological
problems. The first strategy is about the mechanical obstruction of catheter (Lam et al. 2012).
These can be of different types, such as kink in the catheter tubing, a tight suture, inadvertently
closed clamp, blood vessel wall blocking the tip of the catheter.

4CVAD RELATED COMPLICATIONS
Preventive measures
Managing these mechanical problems can reduce a huge amount of occlusion occurring
in patients with CVC injected (Puiggros et al. 2012). Rearrangement, repositioning of catheters
inside the blood vessel is can be done by making patient move from side to side, or making him
stand or sit. However, in case of Jim, making him move or stand is not possible, as he is not
responding to the medical interventions (Drasler, Pedersen and Ungs 2016). Further, the
thrombotic catheter obstruction can be removed, by using a device called lingo gram, a device
detects the intraluminal clot or fibrin sheath (Cohen et al. 2013). A drug can also be used to
remove the cathedral obstacle. This drug is named as Alteplase and minimal dose of it can treat
the thrombotic occlusion after the injection of CVC intravenously (Lam et al. 2012). The
experiments or researches included for this complication are level II of level of evidence. It
includes RCTs and lower level of meta-analysis studies. The preventive measures that have been
used here as preventive instruments for Jim are tried and tested on a large population and are
being used in several countries.
Further, the third complication, that Jim suffered while his treatment and after injection
of CVC intravenously was Local skin irritation. After the application of the catheter, it can be
seen that the insertion site of the catheter has become red and swollen (Timsit et al. 2012). There
can be several reason behind this swelling of the catheter insertion region of the patient’s body.
One of which is the high density of the microorganisms in the catheter insertion site, due, to
which the inflammation and anaphylaxis leading to type 1 hypersensitivity in the body, which
can lead to autoimmune disease (Raphael et al. 2015). Further, the preventive measure for such
skin treatment is the povidone iodine and chlorhexidine, which can be used as a solution for the

5CVAD RELATED COMPLICATIONS
CVC related skin irritation. On the other hand, generate irritation can be from the injected
catheter and its low quality as mechanical defect in the catheter can also induce type 3
hypersensitivity in the patient leading to autoimmune disorder (Loveday et al. 2014). According
to the researches, ()there has been only one comparison based trial has been performed to
understand the activity of chlorhexidine-based solution to 5 percent alcoholic povidone iodine
(Mimoz et al. 2015).
Preventive measures
Chlorhexidine-based solution has been proven 50 percent more active than the povidone
iodine solution as it removed the catheter related skin irritation by 50 percent. One factor that
should be mentioned in this scenario is the, tolerance level of chlorhexidine-based solution
towards the inflammation; anaphylaxis is quite higher than that of the povidone iodine solution.
Therefore, this solution should be used in the case of Jim for the preventive and management
measures of local skin irritation after the ingestion of CVC catheter in the veins (Hooper,
Littman and Macpherson 2012)). One more reason behind the skin irritation of Jim could be his
lack of nutrition and weaker immune system, which has made him more sensitive to outer
environment (Wahren-Herlenius and Dörner 2013). Further, to prevent skin irritation, the
exposed skin should be wiped with soap or some other liquid cleansing solution as it will help to
keep the skin dirt free and allergen free. Therefore, preventive measures should include
application of medicines to improve his immunological condition and resist the hypersensitive
condition of the patient. Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, an
iodophor or chlorhexidine gluconate) before peripheral venous catheter insertion. Further,
prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous

6CVAD RELATED COMPLICATIONS
catheter and peripheral arterial catheter insertion and during dressing changes. If there is a
contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70% alcohol can be used as
alternatives (Department of Health and Human Services USA, 2018). Evidence based analytical
studies have been used in this complication description and the level of evidence is level V of
evidence.
In the conclusion, it can be said that, Jim suffered from drastic physical complications
and after he doctors checked his physiological conditions and did few primary checkups, they
inserted a central venous catheter in the right subclavian vein of Jim. After that, there were
several physiological conditions occurred in the body of Jim. Three of which has been discussed
in this assignment. The first complication was CVAD related bloodstream infections, of which
the preventive measures and management skills were mentioned. The second complication was
related to catheter occlusion and its preventive measures are been mentioned. The final
measurement of local skin irritation due to catheter application was discussed critically and
management skills were mentioned as well.

7CVAD RELATED COMPLICATIONS
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