Drug/lipid precipitates The VAD should be evaluated for possible precipitate formation if the fibrinolytic agent fails. Inappropriate concentrations or incompatible mixtures can cause medications to precipitate within the catheter lumen.10 An infusion pH that is too alkaline or too acidotic can cause precipitation. Parenteral nutrition preparations may leave lipid residue, which can cause an occlusion. Treatment of precipitate formation is based on the pH of the infusate used.
Catheter position The catheter can migrate into the subclavian, internal jugular, or innominate vein.3 Malposition may be caused by forceful flushing or changes in intrathoracic pressure associated with coughing or vomiting. The distal tip of a VAD does not remain stationary; it is impacted constantly by body movement. If the catheter becomes coiled, the risk for thrombosis is further increased because intravascular flow resistance becomes elevated, altering the venous flow pattern.5 Palpitations or arrhythmias may be experienced if the tip is located too deep in the atrium. Treatment for a malpositioned catheter includes changing the patient’s position or using a guide wire exchange, fluoroscopic guidance, or catheter reinsertion to reposition the catheter.7
CONCLUSION
An increasing number of ambulatory patients will have an IV device in place at some point during their treatment. The increased need for intravenous access has led to a greater diversity of vascular access devices. Although VADs have been used for more than three decades, numerous clinical dilemmas remain with regard to maintenance care and managing complications. VAD complications can occur during insertion or at any time after placement. Nurses must maintain their knowledge of VADs to prevent, recognize, and appropriately manage its complications. ONA
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Dawn Camp-Sorrell is an oncology nurse practitioner at Children’s Hospital of Alabama, Birmingham, Alabama.
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REFERENCES
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