Hold the Line: CVC Considerations for Vessel Salvage |
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Sunday, June 12, 2022 1:20pm - 2:20pm ET
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Central venous catheters (CVC) are indicated for acute and chronic infusion therapies for the hospitalized child. Though CVCs are critical for some treatment courses, inappropriate CVC procedures are not without consequence. Major vascular complications like thrombosis (Citla Sridhar et al., 2020) and stenosis (Tedla et al., 2018) can be avoided when vessel salvage is considered prior to non-urgent CVC removal. Image discussion: 18-year-old male with no remaining upper extremity vascular access options. A misguided direct IVC dialysis catheter insertion that resulted in occlusive IVC thrombosis around the catheter. Leaving no other sites for dialysis access. There is a lack of standardized protocol for decisions to remove and replace CVCs (Ullman et al., 2020). Addressing this deficit may help identify the need for timely vascular interventions and decrease the risk of acute and long-standing vascular injury. The objective of this presentation is to consider long-term consequences of central venous access when CVC removal/replacement is indicated. Approach to CVC removal vs replacement should be evidence-based or supported by field expert recommendations. The Infectious Diseases Society of America (ISDA) provides recommendations for CVC removal based on organism and clinical picture (Mermel et al., 2009). When CVC removal is indicated, teams implement an appropriate approach to removal and access. Plans are collaborative including patient/families, nursing, infectious disease, Interventional Radiology, and diagnostic studies to aid in mapping and planning. Fostering a culture that considers long-term consequences of central venous access may be the foundation for vessel salvage and preservations. |
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Mehvish Abbasi, MSN, CPNP-PC, CRNPediatric Nurse PractitionerChildren's Hospital of Los Angeles |
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Nurse Practitioner in Interventional Radiology at Children's Hospital of Los Angeles. Passion includes educating advance practice providers, and quality improvement |
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