JENIS AKSES VENA SENTRAL KELOMPOK 4
CVAD
CVADs is a device that help a patient receive treatments for various medical conditions through a vein that leads to patient heart, into large central vein most commonly the internal jugular, subclavian, or femoral) and advanced until the terminal
lumen resides within the inferior vena cava, superior vena cava, or right atrium
Thin, soft, flexible tube that is inserted into large vein leading to
the heart.
CVAD
Various access techniques and devices were developed for many indications, including total parenteral nutrition
administration, dialysis, plasmapheresis, medication administration, and hemodynamic monitoring, and to
facilitate further complex interventions such as transvenous
pacemaker placement
INDICATION
•Multiple infusions may be incompatible with peripheral intravenous access, such as vasopressors, total parenteral nutrition, chemotherapy, and other acidic medications to peripheral veins.
•Inability to obtain venous access in emergent situations.
•The initiation of extracorporeal therapies, such as hemodialysis, plasmapheresis, and continuous renal replacement therapy.
•Hemodynamic monitoring, including central venous pressures.
•For venous interventions, including inferior vena cava filter placement, thrombolytic therapy, transvenous cardiac pacing, and intra-venous stenting
CONTRAINDICATION
Absolute contraindications:
•Active skin or soft tissue infection at the potential site of the central line.
•Anatomical distortion at the site includes implantable/indwelling hardware, such as hemodialysis catheters and pacemakers.
•Vascular injury proximal or distal to the site of the catheter insertion, such as in traumatic injuries.
Relative contraindications:
•Coagulopathy, though the actual incidence of clinically significant bleeding is around 0.8%.
•Thrombocytopenia seems to correlate with a greater risk of adverse events.
•Uncooperative awake patient.
•Distortion of landmarks by congenital anomalies or trauma.
•Morbid obesity.
• PICC diinsersi ke vena tepat di atas siku dan dimasukkan
hingga ujungnya berhenti di pembuluh darah yang lebih besar tepat di atas jantung.
• PICC dapat dipasang di
departemen radiologi, ruang operasi, dan pada bed side.
Diberikan anestesi lokal
• Indikasi : perawatan yang
diharapkan berlangsung lebih dari seminggu, tetapi kurang dari 6 bulan.
• Tidak tahan air
CVC dimasukkan ke dalam :
• Vena subklavia
• Vena jugularis di leher
• Vena femoralis di
selangkangan Anda
CVC ditahan dengan
jahitan atau penjepit
khusus yang dipasang
pada kulit Anda.
TUNNELED CVC (HICKMAN)
• Tunneled CVC berjalan di bawah kulit dan terminasinya jauh dari lokasi akses vena.
• Tunneled CVC dapat dipasang selama berminggu-minggu
hingga berbulan-bulan,
sedangkan non-tunneled CVC
harus diganti setiap beberapa
hari hingga seminggu.
PERBEDAAN TUNNELED VS NON-TUNNELED CVC
Perbedaan Non-Tunneled Tunneled
Insersi Dekat lokasi vena Jauh dari lokasi vena
Desain cuff Tidak ada cuff Ada cuff yang membantu
mencegah pertumbuhan mikroba di sekitar lokasi insersi
Penggunaan Terapi IV standar, prosedur jangka pendek
Prosedur jangka panjang
Keamanan Prosedur pemasangan lebih
mudah dan minim risiko perdarahan
Cuff meminimalisir infeksi.
Prosedur pemasangan lebih kompleks
Durasi Pemakaian Jangka pendek Panjang
