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Haematological emergencies

Central venous access device complications

Definition

A central venous access device (CVAD) is a catheter that is inserted into the central venous system (Dougherty and Lister [64], RCN [245]) with the tip placed within the:
  • superior vena cava (SVC)
  • inferior vena cava (IVC)
  • right atrium (RA).
CVADs allow medications to be delivered directly into larger veins, are less likely to clot, and can be left in for long periods. They are small, flexible tubes placed in large veins for people in whom frequent access to the bloodstream is required. The most common uses of CVADs and their advantages are shown in Table 26.2.
Table 26.2  Central venous access devices: most common uses and advantages
Common usesAdvantages
Administration of medications: antibiotics, chemotherapy drugs, other intravenous drugsAvoids problems that result over time from administering highly irritant medications through small veins with peripheral devices such as irritation of the vein and thrombosed veins
Administration of fluids and nutritional compoundsHigh rates can be given over a short period
Transfusion of blood products 
Multiple blood tests for diagnostic testingAvoids inflammation and scarring from multiple needlesticks
 Increases comfort and reduces anxiety of possible multiple venous access
There are several risks and complications related to CVADs, of which the most common will be discussed in this section. For further information regarding the insertion, care, use or management of vascular access devices, including extravasation of systemic anticancer therapy (SACT), please refer to Chapter c23.
The most common complications associated with CVADs are thrombosis, infection and extravasation (Dougherty [63], Kayley [127], RCN [245]). The patient should be told to report signs of redness and tracking at the exit site, along the skin tunnel or up the arm, any oozing at the exit site and fevers or rigors.
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