| Care of the Valved CVAD |
By Kelli Rosenthal, MS, RN, BC, CRNI, ANP, APRN, BC
General Care of the Valved CVAD
Verify tip placement in SVC prior to use with chest x-ray
Change MVT dressings at least weekly and whenever soiled, damp, or non-adherent on all four sides.
Change tape and gauze dressings q 48 hours and whenever soiled, damp, or non-adherent.
Flush valved catheters with double the volume of 0.9% NaCl of the internal lumen of the catheter plus any accessories, or according to manufacturer’s recommendations. PASV valves (valve in the hub) should be flushed with 10 cc 0.9% saline solution before and after each use. If the valve becomes damaged, (more common with Groshong due to its placement in the bloodstream) treat like an open-ended catheter and heparinize per open-ended protocols. A common protocol is 3 cc 0.9% NaCl weekly or after each infusion. Ports are generally flushed with 5 ml 0.9% NaCl monthly and after each use. Ports with PASV valves are flushed with 10 cc 0.9% NaCl at least monthly and after each use. Treat each lumen of a multi-lumen catheter individually and ensure that all unused lumens are flushed at least weekly.
Valved catheters should not be clamped when not in use as applying positive pressure to the line encourages blood to back up into the catheter as the valve is now open.
Observe condition of sutures and/or incision line with each dressing change. Notify physician of redness, induration, or drainage.
Note the external markings of the catheter with each dressing change. When external length changes, internal tip placement has changed as well. Notify physician of any discrepancy and reconfirm tip placement with a chest xray if catheter position changes prior to infusing any therapy that should go through a central catheter.
Change injection cap when dressings are changed, after lab draws, and whenever compromised.
All connections should luer lock together securely.
Never forcefully flush a catheter against resistance. Notify physician if catheter becomes sluggish or is occluded.
Flush before and after a lab draw with at least 20 ml 0.9% NaCl.
Never use a pressure injector for instilling contrast medium for CT scans.
Blood Sampling - Valved Devices
Flush with 10 cc 0.9% NaCl for injection solution if desired. (Omit this step if drawing blood cultures.) Remove sterile cap, swab hub threads with an alcohol swab, and attach a 5 cc or 10 cc syringe to the hub.
Aspirate 3-5 cc of blood and discard, or if drawing from hemodynamically compromised/pediatric patients, you may aspirate and gently re-inject this aspirate, repeating several times to prevent obtaining a contaminated sample.
Attach a 10 cc or larger syringe to the hub and slowly withdraw enough blood to obtain all necessary lab studies.
Using a 10 cc or larger syringe, flush catheter with a minimum of 20 cc of sterile 0.9% normal saline for intravenous injection using a “pulsatile” or “stop/start” technique. Disconnect syringe, swab catheter hub threads with an alcohol swab. Let dry. Place new sterile end-cap or needleless system valve using aseptic technique.
Use a needleless transfer device to transfer blood from syringe to correct vacuum tubes for ordered studies. Fill tubes with preservatives first to prevent clotting. Catheters maintained with only saline may be used to obtain clotting studies.
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