The client who requires long-term intravenous therapy and will be having a central VAD inserted asks the nurse what the differences are between a tunneled and a nontunneled central VAD. What is the nurse's best response?

Question

A. "Tunneled VADs can remain in place longer and have a lower risk for infection than nontunneled VADs."
B. "Nontunneled VADs protrude through the skin surface and tunneled VADs are totally implanted beneath the skin surface."
C. "Nontunneled VADs can only be inserted into peripheral blood vessels and tun-neled VADs are inserted into central blood vessels."
D. "Tunneled VADs can be used for drawing blood samples, but blood cannot be drawn for laboratory analysis through a nontunneled VAD."

Answer 1

A
Tunneled VADs are long, inserted through the skin, and "tunneled" for several inches through the subcutaneous tissue before being placed into a blood vessel. These VADs have a cuff that is positioned inside the subcutaneous tunnel to help hold it in position. Fibrous tissue grows around the tunneled sheath, forming a physical barrier to prevent microorganisms from migrating along the sheath and entering the blood vessel. In general, tunneled VADs remain in place longer and have a reduced risk for sepsis compared with nontunneled VADs. Both tunneled and nontun-neled VADs can have multiple lumens, can be inserted centrally, and can be used for blood draws.