Vascular access devices (VADs) are crucial for patients requiring long-term intravenous treatments. However, they can sometimes malfunction or develop complications. Here are the key warning signs that a VAD may need adjustment or replacement:
Physical Symptoms:
- Pain, redness, swelling, or discharge at the insertion site
- Swelling in the face, chest, neck, or arm on the side of the VAD
- Prolonged bleeding (more than 10-15 minutes) after dialysis for grafts and fistulas.
- New or increasing areas of ‘swelling’ or ‘ballooning’ near the access site
Functional Issues:
- Difficulty with blood return from the device
- Resistance when injecting medicine or fluids into the line
- Blood pump on the dialysis machine reading less than 400 for grafts/fistulas or 300 for catheters
- Repeated difficulty with the dialysis staff being able to ‘stick’ the access
- Catheter becoming loose or moving out of the skin
Systemic Signs
- Fever or chills, which may indicate infection
- Signs of a blood clot, such as bulging veins near the line
- Sudden onset of dyspnea, chest pain, altered mental status, or other acute cardiopulmonary and neurological symptoms (which may indicate air embolism)
Device-Related Issues
- Leaking catheter
- Breaking of the port clamps on a catheter
- VAD out of place, which may occur after severe coughing or vomiting
If any of these warning signs are observed, it’s crucial to notify healthcare providers immediately for proper evaluation and intervention. Regular monitoring and prompt attention to these signs can help maintain the functionality of the VAD and prevent serious complications.
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References:
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Nursing Center. (2024 July) Complications of Central Vascular Access Devices. https://www.nursingcenter.com/getattachment/Clinical-Resources/nursing-pocket-cards/Complications-of-Central-Vascular-Access-Devices/Pocket-Card_Complications-of-Central-Vascular-Access-Devices_July-2024.pdf.aspx