The Ins and Outs of Venous Access

March 25, 2008 by  
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Why a venous access device?

Venous, meaning vein, is the fastest route for delivering medication, blood and blood products in a consistent and safe and efficient manner.

TYPES OF VENOUS ACCESS DEVICES

The peripheral line

Peripheral access is obtained using a peripheral vein (hands, arms, feet or legs). Generally the hands and arms are used. Location and placement is determined by the condition of the patient’s veins and the reason for access.

An intravenous catheter is inserted using a needle covered by a flexible sheath. After insertion the needle is removed and the sheath remains inserted connected to a hub. This hub may then be connected to tubing for continuous intravenous therapy (IV) for blood or blood products, antibiotics or other medications. Often when the IV is completed and the site is still is in good condition, the access hub will receive a small cap. The cap will be used to flush the site with saline per protocols and is available for future medication delivery.

A sterile dressing will be placed over the insertion site and the catheter will remain in place for several days. These sites are not used for blood draws.

Central Venous Access Device:

All Central Venous Access Devices involve a catheter tip which rests in the superior vena cava of the heart, except a femoral (groin) line whose tip sits in the inferior vena cava.

X-ray is used to verify the correct placement of all CVADs.

A CVAD is chosen over a peripheral line for many reasons. Many drugs, especially chemotherapy medications used to treat cancer are damaging to small peripheral veins, resulting in the collapse, scarring or occlusion of the site. This leads to multiple sticks for new peripheral access sites. A CVAD will stay in place for a longer period of time, generally for the entire therapy regime or longer and most patients will go home with the device. Patients are then taught how to care for their CVAD devices at home.

A CVAD may eliminate the need for multiple laboratory blood draws.

Today’s CVAD catheter products enable the infusion of several medications, some incompatible, at the same time.

It is important to discuss with your doctor why you are having a CVAD placed. The more you know about your therapy the more comfortable you will be.

Four Common Types of CVAD:

bard-powerpicc.jpg

PICC Line

This CVAD is called a peripherally inserted central catheter (PICC) and is non-surgically placed into the antecubital area of the arm (the front surface of the arm, at the elbow). The catheter which has a guide wire is then threaded to rest in the superior vena cava (the top opening of the heart) Several companies make this device. The photo shows a Bard brand PICC line, however; there are other brand names you may hear about such as Poly PICC or Groshong. Note the lumens or pigtails. These lines may be inserted at beside by a specialist nurse or a physician. These lines may be used for laboratory blood draws.

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Patient Advocacy

March 6, 2008 by  
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Who is your advocate?

Unfortunately, when you are feeling your worst is when you must be your most diligent. The battling cancer war includes a few small skirmishes along the way. No matter what your battle plan you should have help in the form of an advocate.

Here are just some of the reasons why.

1. Inputting information:You’ve just been diagnosed with cancer and you’re being overloaded with new terminology and massive amounts of information. Your advocate will be taking notes in the doctor’s office, at the clinic and anywhere you are introduced to new information. You can sit back and let your head spin.

2. Health care decisions: Post op, as you struggle with your nasogastric tube is not the time to wonder what your doctor said about treatment options, or where your notes are on side effects of that new pill you took or to hope you have the strength to surf the web for information. Your advocate can help you sift through information, do research and assist you in making the best decision possible for your care.

3. Your barrier: The health care advocate is the person who stands between you and the world. Your advocate is the person who gets up and approaches that intimidating clerk in the waiting room and reminds them you have been waiting an hour. They will also block the door to your room when you are napping and someone wants to scrub your floor. Enough said.

4. Mistakes happen: No one likes to discuss mistakes, especially not your caregivers. But as long as there are humans, there will be human error. Your advocate has your medical history and can double check every pill brought to you and every IV bag that is hung.

5.Dealing with red-tape: The maze of insurance and hospital bureaucratic regulations is overwhelming when you feel 100%. Let your advocate play phone tag and chase paperwork from simple pre-qualification details to following up insurance payments.

6. The squeaky wheel gets greased: Here’s a little secret from the nurse’s break room. The patient with the annoying friend who keeps pushing the call button for pain meds exactly when they are due, is likely to get the nurse’s attention first. I’m not saying this is fair but then again, the cancer patient already knows life is far from fair.

7. Hand holding: There is much to be said for the simple human touch. Consider how much time passes in the typical hospital day without human touch–real human touch, not clinical touch, as though you were inanimate. The simple squeeze of a hand communicates far more eloquently and contributes more to your recovery than words.

How to Find an Advocate:

Consider who you trust and who you would be willing to be an advocate for if roles were reversed. Sometimes several close friends are willing to share your advocacy.

Additionally there are professionals whose job is patient advocacy; these include private duty nurses. They’ll put your needs first because they are being paid to. Ask you hospital social worker or doctor if they can recommend someone.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.