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


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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6. Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007;7(10):645-657.

7. Camp-Sorrell D. Access Device Guidelines: Recommendations for Nursing Practice and Education. 3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2011.

8. Vescia S, Baumgärtner AK, Jacobs VR, et al. Management of venous port systems in oncology: a review of current evidence. Ann Oncol. 2008;19(1):9-15.

9. Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl 1):S22-S30.

10. Camp-Sorrell D. State of the science of oncology vascular access devices. Semin Oncol Nurs. 2010;26(2):80-87.

11. O’Grady NP, Alexander M, Burns LA, et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011; 39(4 suppl 1):S1-S34.

HOW TO TAKE THE POST-TEST: To obtain CE credit, please click here after reading the article to take the post-test on myCME.com.