Central Vascular Access Lesson Description – Mitch Taylor Define central venous catheter (CVC) and associated terms.  Describe the anatomy associated with central line placement.  Verbalize the differences between the different central venous  access devices and identify nursing care associated with each device. Discuss indications and nursing care of patients with central  venous access devices. Identify symptoms of common complications of central venous  access devices and nursing interventions to prevent and manage these complications. Categorize different IV solutions in terms of isotonic,  hypertonic, and hypotonic solutions. Guidelines U.S. Department of Health & Human Services  Provides a website for national guidelines for  evidenced based practice National Guideline Clearinghouse  http://www.guidelines.gov/  http://www.guidelines.gov/summary/summar  y.aspx?view_id=1&doc_id=8338#s24 GLOSSARY OF TERMS Biocompatibility - the quality of not having  toxic or injurious effects on biological systems. - Dorland's Medical Dictionary Central Venous Catheter – tip in distal third of  the Superior Vena Cava (SVC) Central Venous Tunneled Catheter – tip in  SVC, but insertion is tunneled under the skin before accessing the vein. Distal - means furthest from the heart  (perspective) on the body, but on a catheter, the distal part would be the furthest away from the infusion ports. Perspective For example, when we are talking about  hypertonic, isotonic, and hypotonic solutions, we are talking about it from the perspective of inside the vessel. Isotonic Vessel Cell Cell Cell Cell Cell Isotonic • The vessel always wants to look like America’s Top Model – perfect or always look isotonic. It will do what ever it needs to accomplish that look. Hypertonic Vessel Cell Cell Cell Cell Cell Perspective So, a hypertonic solution means it is thicker or more  concentrated than what is normally in the vessel. And, because the body seeks to normalize things in  the vessel, it will send fluid to the vessel to get it to look normal or isotonic again. It robs from the cells and tissues to achieve the look  of isotonic in the vessel. What this does then is add more fluid into the vessels  and onto the heart, which the heart sends to the kidneys to urinate out of the body. Hypertonic Vessel More Fluid Cell Cell Cell Cell Cell Perspective A hypotonic solution then does the opposite.  It has less stuff or is thinner or is less concentrated than what is normally in the vessel. So the body will shunt fluid out of the vessel  into the cells in order to make the vessel look normal again. This will reduce the amount of fluid in the  vessel and reduce the amount of work on the heart.