Forum topic

 I think the message at AVA was that we have overused all types of CVADs, including PICCs. We are seeing the ramifications of greater complications such as catheter associated vein thrombosis. I think we need to carefull examine the issues of what is a true indication for a CVAD, when a PIV or midline is indicated, and complete nursing assessment of the whole patient to make that determination. We have tried to dumb-down this assessment with simple decision-trees, etc. I have always maintained that was not the most appropriate approach because the decision is so complex. The decision for any type of CVAD should not rest on one characterisstic such as pH or osmolarity. It is the complete patient assessment including medical history, primary and secondary medical diagnoses, nursing diagnoses or problems, the characteristics of the infusion therapy, the skills of the inserters, and the setting where the therapy is to be delivered. All must be considered to provide the greatest benefit with the least risk to the patient. 

Regarding infiltration and their prevention, our online course has a very large section on this topic. Learn more about this course at Infiltration and Extravasation from Vascular Access Devices - Lynn Hadaway Associates, Inc.

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