Comprehensive Nursing Pharmacology Q 15
The primary complication of a central venous access device (CVAD) is:
A. Thrombus formation in the vein.
B. Pain and discomfort.
C. Infection.
D. Occlusion of the catheter as the result of an intra-lumen clot.
Correct Answer: C. Infection.
A foreign body in a blood vessel increases the risk of infection. Catheters that come outside the body have an even higher risk of infection. Most infections are caused by skin bacteria. Other infective organisms include yeasts and fungi. Infection is a serious delayed complication associated with central venous access that can lead to sepsis, shock, and death. Central line-associated bloodstream infections have a reported incidence between 80–189 episodes per 100,000 patient years, and the Centers for Disease Control and Prevention (CDC) estimates the additional cost per infection to be on average approximately $16,550.[45] Mortality related to central line infection can occur in up to 25% of cases. Infections become established on the catheter through the production of biofilm. Staphylococcus aureus and Staphylococcus epidermidis are the two most common pathogens.
Option A: Long-term catheters can also lead to venous thrombosis. Symptoms include ipsilateral extremity erythema, edema, and paresthesia. Additionally, thrombosis can lead to superior vena cava syndrome, which can present as head and neck swelling. The incidence of superior vena cava syndrome is estimated to be 1 in 1,000 cases. Subclavian central venous catheters have the lowest rate of thrombosis. Femoral lines have the highest rate of thrombosis. Cancer patients have a higher risk of central line thrombosis of up to 41%. Primary thromboprophylaxis has no proven benefit in the oncologic or cancer-free population.
Option B: Once placed, these lines do not cause pain and discomfort. A central line is necessary when the client needs drugs given through the veins over a long period of time, or when the client needs kidney dialysis. In these cases, a central line is easier and less painful than having needles put in the veins each time the client needs therapy.
Option D: An occlusion can result from the precipitation of calcium phosphate crystals when calcium and phosphorus are co-administered at inappropriate concentrations. If the pH of an infusion is too alkaline or acidic, precipitation can occur. Parenteral nutrition preparations can leave a lipid residue that can obstruct a CVC.