Vascular access device (VAD) selection represents a crucial moment in vascular access management (VAM).<\/p>\n
\u201cA peripheral vessel selection is not the same as a central vessel selection because when we look at tips for haemodilution, we can run anything through a central line… [For] peripheral circulation, we have to be very much aware of pH, osmolarity and the vesicant nature of our drug; how we’re administering this drug and for how long…\u201d according to Kathy Kokotis, Director of Market Development, BD.<\/p>\n
Ms Kokotis spoke on \u201cHow to choose the appropriate VAD for your patients?\u201d on the first day of BD MACOV@23, a virtual edition of the Multidisciplinary Advanced Course on Vascular Access (MACOVA) held on 5\u20137 September 2023. She highlighted three crucial factors which should be considered when selecting a VAD.<\/p>\n
When assessing a patient\u2019s vascular anatomy, examine vein diameter and blood flow.1<\/sup><\/p>\n If more than one third of a blood vessel is occupied by a catheter, this may reduce blood flow to the area.4<\/sup> This increases the risk of VAD-related thrombosis.4<\/sup> The haemodilution of medication administered intravenously depends on blood volume and flow velocity.5<\/sup> It is thus important to choose a VAD with the smallest outer diameter.1<\/sup><\/p>\n More on this topic: <\/strong>How to identify and reduce the risk of catheter-related thrombosis<\/a><\/p>\n Let\u2019s start with pH levels and osmotic concentrations. With regards to pH, infused solutions\/medications should be isotonic and euhydric (i.e., physiological pH).6<\/sup> Excessive pH or osmolality increase the risk for possible damage to veins or blood cells.6<\/sup><\/p>\n For example, when considering whether to use a central vascular access device (CVAD) or peripheral vascular access device (PVAD) for infusing parenteral nutrition (PN), the eighth edition of the Infusion Therapy Standards of Practice<\/em>\u00a0 recommends choosing a CVAD for final PN concentrations that generate an osmolarity rate of over 900 mOsm\/L.1<\/sup><\/p>\n According to the World Congress on Vascular Access (WoCoVA)<\/a>, there is broad consensus in the literature on using CVADs for infusions with osmolarity rates of over 600 mOsm\/L and pH levels below 5 or above 9.7 <\/sup>Other infusate characteristics to keep in mind when selecting a VAD include verifying if the substance that will be infused is an irritant or vesicant.1<\/sup><\/p>\n An irritant is, \u201cAn agent capable of producing discomfort (e.g., burning, stinging) or pain as a result of irritation in the internal lumen of the vein with or without immediate external signs of vein inflammation.\u201d1<\/sup> A vesicant is, \u201cAn agent capable of causing tissue damage when it escapes from the intended vascular pathway into surrounding tissue.\u201d1<\/sup><\/p>\n According to the European recommendations on the proper indication and use of peripheral venous access devices (ERPIUP), irritants and vesicants should preferably be administered via a CVAD.7 <\/sup>In addition to the above considerations, it is recommended that each ward have a list of peripherally incompatible intravenous medications.7<\/sup> This can be helpful when choosing whether to use a PVAD or CVAD.7<\/sup><\/p>\n More on this topic:<\/strong> PICC line or port catheter: Which one for cancer patients?<\/a><\/p>\n\t\t\t\t\t \n\t\t\t\t\t\t\t\t<\/i>\n\t\t\t\t\t\t\t\tBecome a VAMbassador to get access to the full article\t\t\t\t\t\t\t<\/p>\n\n\t\t\t\t\t\t\tVein diameter can vary based on changes in temperature:<\/h3>\n
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Factor 2: Consider infusate characteristics for vascular access device selection<\/h2>\n