What is a primary contraindication for using a tunneled central venous access device (CVAD)?

A primary contraindication for using a tunneled central venous access device (CVAD) is the presence of a bloodstream infection. When a patient has an active bloodstream infection, introducing a tunneled CVAD poses a significant risk of further complicating their already critical situation. The device creates a direct path to the bloodstream, providing a potential route for pathogens to enter. Therefore, it is crucial to address any existing infections prior to the insertion of a tunneled CVAD to minimize the risk of septic complications.

In contrast, the other scenarios reflect situations where a tunneled CVAD might be more appropriately considered. Difficulty in intravenous access may indicate a need for a more reliable access method, which a tunneled device can provide in the long term. Short-term medication infusion does not align with the intended use of a tunneled device, but it does signal that another access solution might be necessary temporarily. Medication infusion for months suggests a longer treatment plan that may align with the purpose of having a tunneled CVAD to facilitate prolonged therapy, although it requires careful management to avoid complications.