CHAPTER 2


EXPERT INSIGHT


Although current guidelines do not specifically recommend against the use of midline catheters for peripheral PN, it should be noted that signs of phlebitis may be obscured with midlines. Midline catheters should be used with caution.1,16,17


Complications of Central Vascular Access Devices


By using a CVAD, many of the technical problems encountered with peripheral PN solutions can be avoided. However, there are potential adverse events and risks associated with any type of PN administration. Early complications associated with a CVAD are often related to place- ment of the device, whereas late complications can be infectious or noninfectious. Box 2.3 describes early complications related to VAD place- ment, most of which are uncommon.1,6,18


Box 2.4 outlines late noninfec- tious complications that may occur even after successful placement.1,5,18


BOX 2.3 Early Complications Associated With Central Catheter Placement1,6,18


Complication Description Pneumothorax


ƒ Most common serious complication


ƒ Occurs when there is a puncture of the parietal and visceral pleura and the lung; air accumulates in the pleural space, causing collapse of the lung


ƒ Treatment depends on severity; serious cases require chest tube placement until the air leak seals


Hemothorax or hydrothorax


ƒ Hemothorax: perforation of a central venous or arterial blood vessel during catheter placement


ƒ Hydrothorax: injury of the thoracic duct (chylothorax) or when the catheter or some of its side holes are misplaced in the pleural space, permitting fluid infusion through the catheter to drain into the chest cavity


ƒ Serious incidents require a chest tube or surgical repair Box continues


22


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149