The placement and the presence of a vascular access device (VAD) put patients at risk for complications during both the insertion process and VAD dwell time. Systemic complications such as catheter-associated bloodstream infection (CABSI), air embolism, and circulatory overload are serious and can be life-threatening, yet are preventable when evidence-based prevention and care practices are employed. The impact of some local complications, such as phlebitis or infiltration, is minimized when the nurse provides thorough and frequent assessments, educates the patient and family members, and identifies early signs and symptoms that allow for prompt action. There are numerous factors that affect the risk for VAD-related complications (Fig. 9-1). These include:
- Using appropriate products and clinical procedures in VAD-related care. Considering skin antisepsis, alcohol-based chlorhexidine solution is preferred for infection prevention. However, some patients may have a sensitivity to the solution or to a transparent dressing, resources may be limited, and alternative options must be implemented. Placement of VADs in accordance with procedures that minimize risk is critical, such as adherence to Aseptic Non Touch Technique (ANTT) (see Chapter 2).
- Using products for appropriate indications, such as for the right device and the right patient population.
- Using products correctly. The best product for the appropriate indication may be implemented but must also be used correctly. Examples include proper placement of chlorhexidine dressings, following recommended manufacturer guidance in removal and replacement of securement devices, and appropriate disinfection of needleless connectors (NCs) whether using alcohol wipes, alcohol-based chlorhexidine wipes, or disinfection caps.
- The educated nurse understands potential complications, signs and symptoms, and preventive interventions and employs appropriate interventions in the event of a complication. Given that a number of complications are preventable, nursing knowledge is critical.
- Patient/caregiver education becomes especially critical for those patients living at home with a VAD and perhaps administering their infusions.
- Individual patient risk factors such as skin/vein fragility or lack of ability to respond to or report symptoms may increase risk for complications such as phlebitis or infiltration. It is always important to recognize such risk factors that may result in the need for increased frequency of monitoring.
In this chapter, complications are categorized as local, systemic, and central VAD (CVAD) related. The etiology, signs and symptoms, preventive interventions, and treatment are addressed for each complication. Documentation points are also provided.
INS Standard: Vascular access devices are removed when clinically indicated: unresolved complication, discontinuation of infusion therapy, or when no longer necessary for the plan of care (Gorski et al., 2021, p. S133). Clearly complications are prevented when the VAD is removed if no longer needed. Yet in many organizations, a peripheral IV catheter (PIVC) in particular, may be left in place “just in case,” even if the patient is not receiving active infusions and is able to orally hydrate. Unused or “idle” IV catheters are common and are associated with adverse outcomes, including increased risk of infection, intensive care unit admission, and phlebitis (Bercerra et al., 2016; Silk et al., 2021).
Media Link: Chapter post tests and answers are provided on FADavis.com, along with case studies and critical thinking activities.