CVAD indications include:
- Intravenous therapy that requires a CVAD for administration
- Ongoing therapy post-hospitalization
- Hemodynamic monitoring
- Transvenous cardiac pacing
- Extracorporeal therapies
- Large bore venous access is required to support high-volume flow required for many extracorporeal therapies, including hemodialysis, continuous renal replacement therapy, and plasmapheresis.
- Venous Access Team recommendation as only option for venous access
Indications for a central vascular access device (CVAD) can change daily. Limiting the duration of use for central lines will decrease the patient’s risk for central line-associated infection (CLABSI) and deep vein thrombosis (DVT). Ask:
- What is the current indication for this CVAD?
- Blood sampling for routine laboratory testing is generally not a true indication for maintaining CVAD placement.
- Antibiotic therapy is not necessarily an indication for maintaining CVAD placement.
- Does this patient’s infusate(s) require a central line for administration or can therapy be accomplished with another vascular access device (e.g., ultrasound placed peripheral IV or midline catheter)?
- Refer to the Intravenous Administration of Formulary Medications – Adult – Inpatient/Ambulatory or Intravenous Administration of Formulary Medications – Neonatal/Pediatric – Inpatient/Ambulatory Clinical Practice Guidelines to determine if central vascular access is required.
- Is the CVAD necessary for ongoing therapy?
- It’s tempting to maintain CVAD placement “just in case.” Unless the patient’s plan of care outlines intended ongoing therapy that requires a CVAD (e.g., outpatient use for extended treatment), it’s best to remove the device.
The CVAD Maintenance bundle provides evidence-based interventions for the maintenance of central lines to prevent central line associated blood stream infections (CLABSIs).
Please refer to the CVAD Maintenance Bundle for expectations with maintenance practices.
- Daily CHG treatment is an infection control strategy that reduces the density of potential microbial pathogens on a patients’ skin and decreases the potential for infection.
- The term treatment is to be used instead of bathing, as it is important the patient gets the treatment everyday.
- Education should be given to patients who refuse the treatment along with an explanation to why it is important.
- Refer to the HFFY Daily Chlorhexidine Gluconate (CHG) Treatment for Patients > 2 months of Age from the Due Date (#7403) to help with education
- If the patient continues to refuse, please inform your CTL, CNS or manager
Adult Inpatient 2 Person Dressing Change
2 Person Dressing Change Video
Two-person Adult Central Vascular Access Device (CVAD) Dressing Change Skills Checklist
Central Line Audit Forms
Guidelines, Policies and Protocols
Midline Intravenous Peripheral Catheters: Use, Maintenance and Removal (Adult)
Your Midline Intravascular Catheter
Understanding your Peripherally Inserted Central Catheter (PICC)
3M Tegaderm CHG Dressing Application and Removal – IJ
3M Tegaderm CHG Dressing Application and Removal – PICC
Scrub the Hub (Video)