In this case study why would the RN choose an insertion of CVAD over a PICV to administered PRBC.

Jane Wilson is a 30-year-old female who presents to the regional Emergency Department (ED) by herself. She is hobbling up to triage whilst holding her left leg. Jane reports she had fallen off her horse and has suffered a deep and dirty penetrating laceration to her left thigh. Jane appears alert and orientated. Jane can recall all history of events and answer questions appropriately. Jane has wrapped her thigh with a towel to stop the bleeding. In the ED the towel is removed, and the wound is irrigated with normal saline before being redressed with a pressure bandage. It is not possible to insert a peripheral intravenous (IV) canula, so a decision to obtain access through a Central Venous Access Device (CVAD). The CVAD has been performed on Janes L) Jugular vein under sterile technique. The CVAD is patent and secured with sutures and a transparent IV 3000 dressing. Triage Observation Airway: Patent, own, RR: 16 Sp02: 92% on Room Air (RA) BP: 105/52 HR: 118, regular T: 35.5 Pain 6/10 GCS 15 BGL: 5.5 Medical History Nil allergies Denies any alcohol intake or illicit drug use Independent and active Investigations Hb: 89g/L (Cross match report: AB+) X-ray: No bony fractures or abnormalities visible. CT: Deep laceration to left medial thigh. No associated vascular injury present. In the ED, one unit of Packed Red Blood Cells (PRBCs) is administered through the CVAD. After the first unit of blood, Jane is admitted to the surgical ward to wait for surgery as the ED is now becoming overcrowded. 1g Paracetamol and a Stat dose of Ceftriaxone has been administered by ED staff. School of Nursing, Paramedicine and Health Science NRS283_202360 Assessment item 1: Case Analysis. 3 You are working as a Registered Nurse on the Surgical Ward and when you assume care of Jane and when you introduce yourself to Jane it is 1430. Jane appears anxious and remains in pain. Jane can recite her full name, date of birth and can tell you the time and place. It is obvious Jane is worried and tries to call her wife, Emily, but is unable to get in contact. Initial admission observations to the ward Airway: Patent, own, RR: 16 Sp02: 93% on RA BP: 107/60 HR: 105, regular T: 34.9 Pain 6/10 GCS 14 (Eyes open to voice, orientated and obeying commands) BGL: 5.4

ANSWER

Choosing Central Venous Access Device (CVAD) Insertion over Peripheral Intravenous Cannula (PICV) for PRBC Administration: A Case Study Analysis

Introduction

In the clinical scenario of Jane Wilson, a 30-year-old female with a deep and dirty penetrating laceration to her left thigh, the decision to choose a Central Venous Access Device (CVAD) for administering Packed Red Blood Cells (PRBCs) raises important considerations. This essay aims to explore the rationale behind selecting CVAD insertion over a Peripheral Intravenous Cannula (PICV) in Jane’s case, considering her condition, medical history, and clinical presentation.

Clinical Rationale for CVAD Insertion

Deep and Dirty Penetrating Laceration: The nature of Jane’s injury, a deep and dirty penetrating laceration, increases the risk of infection and sepsis. A CVAD insertion offers a more stable access point, reducing the risk of repeated attempts for venous access, which can introduce contaminants into the bloodstream.

Hemodynamic Instability: Jane presents with low blood pressure (105/52) and a rapid heart rate (118 bpm). These hemodynamic indicators suggest the need for rapid and controlled PRBC administration. CVADs provide a larger caliber vein, ensuring a consistent flow rate, which is crucial for patients with compromised hemodynamics.

Inability to Insert Peripheral IV Cannula: The scenario mentions that it was not possible to insert a peripheral intravenous cannula. This could be due to factors like Jane’s low blood pressure, venous collapse, or the severity of her injury. In such cases, a CVAD becomes a reliable alternative for obtaining access.

Need for Ongoing Medications and Fluids: Jane’s condition requires the administration of pain relief, antibiotics, and fluids. A CVAD allows for simultaneous administration of multiple medications and fluids, reducing the need for repeated venipuncture and improving patient comfort.

Surgical Intervention Pending: Jane is awaiting surgery, indicating the need for continuous access. A CVAD ensures uninterrupted access for ongoing treatment, including PRBC transfusions during the waiting period.

Potential Blood Loss and Transfusions: With a hemoglobin level of 89g/L and a deep laceration, Jane is at risk of significant blood loss. PRBC transfusions are essential to maintain adequate oxygenation. CVADs offer a reliable route for efficient transfusion.

Conclusion

In the case of Jane Wilson, the choice of CVAD insertion for administering PRBCs aligns with clinical considerations such as her injury severity, hemodynamic instability, the inability to insert a peripheral IV cannula, and the need for ongoing medications and fluids. The use of a CVAD ensures efficient and controlled administration of PRBCs, reduces the risk of contamination, and supports her medical management until surgical intervention. The decision reflects a patient-centered approach that prioritizes patient safety, comfort, and optimal treatment outcomes.