Chapter 17: Vascular access devices: insertion and management
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Post‐procedural considerations
Immediate care
Following insertion
The dressing should be left intact and changed 24 hours after insertion.
Following removal
Since the vein closes following removal of the catheter, there is usually no bleeding. However, there may be slight bleeding at the exit site immediately after removal because of the passage of the cuff.
Following either removal method, pressure should be applied to the site until the bleeding stops, and a dressing may be required for 24–48 hours. The patient should be encouraged to rest flat for 30–60 minutes to allow the tissue tract time to seal and prevent possible air embolism (Dougherty [129], Galloway and Bodenham [165], McCarthy et al. [304]).
Ongoing care
Following insertion
Healing of the skin tunnel takes approximately 7 days, so at this time the sutures at the entry site may be removed (Dougherty [123]). The exit site sutures should be retained until the fibroblastic response to the Dacron cuff is adequate to secure the catheter, usually within 2–3 weeks (Perucca [369], Stacey et al. [427], Weinstein and Hagle [465]). A transparent dressing should cover the site and be changed weekly until removal of the sutures.
Following removal
Sutures at the incision site should be removed after 7 days (Dougherty [123]).
Education of the patient and relevant others
See ‘Discharging patients home with a VAD in situ’ above.
