3. CVAD

Question 1

indications for CVA devices

Answer 1

1. administer long term IV fluid therapy
2. Antibiotics & other irrittaing meds
3. Chemotherapy
4. Parenteral nutrition / TPN
5. blood products
6. central venous pressure monitoring
7. obtain blood sample

Question 2

non-tunneled percutanous CV Catheter

Answer 2

• insert directly into skin + into internal and externaljugular or subclavain veins
• tip in SVC ir IVC (femoral)
• stitchged into place
• insterted at bedside
• short term - 3-4 wks
• (+)= local anesthesia
• (-)= increased risk of infection, no SC tunneling, increased risk of pneumothorax

Question 3

Tunneled CV catheter

Answer 3

• tunnel thru subcutaneous
• threaded into large central vein or RA
• tip in SVC near RA, proximal at exit site on trunk
• tunnel holds cath in place
• gen anesthesia or procedural sedation
• Dacrun cuff surrounds catheter
• can be long term, years
• (+)= no needlesticks, low maint, secured, lower infection risk
• (-)= external catheter, req. surgical, pt needs to care for cath, restricts some activity

Question 4

Peripherally inserted central line (PICC)

Answer 4

• insert thru large vein of basillica or cephalic vein in arm
• rests in SVC above RA
• nurse can place, tip ends above RA
• if MD, tip in RA
• done bedside
• up to 6 weeks - 1 year
• single/multiple lumen
• (+)= low cost, few activity restrictions, no surgery needed
• (-)= line is not sutured, external catheter, pt needs to care for cath

Question 5

Implanted Infusion Port

Answer 5

• port restx in SC pocket in intra-clavicular fossa, under skin
• cath inserted in big vein and threaded thru RA
• port easily palpated thru skin
• surgery or X-ray
• access port with non-coring Huber needle
• long term, years
• flush policy: q month when not in use
• open ended- req. heparin/ valve ports don’t
• (+)= no external cath, no maint for pt when not used, rare complications, no activity restriction
• (-)= surgical procedure, expensive, can be painful when accessed

Question 6

Dacron Cuff action

Answer 6

• tissue granulates + anchors the catheter
• cuff acts as barrier to prevent spread of organisms
• anti microbial chemicals dissolve in 3 wks

Question 7

Access port with Huber needle

Answer 7

1. needles are straight or 90 deg
2. needle goes thru skin into port
3. change needle q7days

Question 8

TPN

Answer 8

delivery of nutrients thru a central line cath for pts with GI dysfunction, critical illness, or trauma

Question 9

Pts who req TPN

Answer 9

• poor or no oral intake
• progressive weight loss , more thatn 10%
• intolerance to enteral feed
• increased energy needs (burns, sepsis, trauma)
• extended NPO status
• chronic severe diarrhea and vomiting
• GI obstruction
• severe malabsorption
• severe anorexia nervosa (869)

Question 10

TPN composition

Answer 10

• essential fatty acids
• base is dextrose and protein
• pharm adds electrolytes, vitamins, trace elements
• calories from dextrose and fat emulsions

Question 11

TPN NI

Answer 11

• check BGM q4-6hr (110-150)
• sliding scale insulin may be needed
• if PN bag is empty before next admin, give 10% dextrose to replace to prevent hypoglycemia (870)
• change filters + IV tubing q24hr (lipids), q72 (protein +dex)
• control infusion rate by using pump
• examine solution for leaks, color changes, particulate, clarity, fat emulsions cracking
• stop PN bag at 24 hrs empty or not (prevent bacterial growth)
• when going back to PO 60% of caloric needs must be PO before stop TPN

Question 12

monitor TPN effectiveness

Answer 12

• mon VS q4-8hrs
• weigh daily (hydration)
• i/o
• find cause of weight changes
• assess BGM, electr, BUN
• -CBC and hepatic enzymes

Question 13

TPN admin skill

Answer 13

1. Five rights X3
2. connect TPN to correct tubing
3. prime tubing so no air bubbles left , new tube with each bag
4. cleanse port 30 sec, dry 30 sec
5. verify placement, check blood return
6. Flush CVA device to NS usinng turbulence - 10 ml
7. program IV pump correctly
8. Secure tubing

Question 14

TPN documentation

Answer 14

• like IV med +site info/assess
  
  • name of TPN, dose, route, time, signature
  • amount of TPN
  • PT response
  • appearance of IV site
  • period of time to be infused
  • pump or gravity
  • flow rate
  • amount and type of fluid for flushing
• line patency
• crit assess: BGM

Question 15

Initiated with flushing catheter

Answer 15

• too much pressure from syringe can rupture cath
• use only 10 ml + (larger syringe= less pressure/ smaller= high pressure)
• always flush push/pause, increases turpidity, creates + pressure
• discontinue flush if resistance is met , never force a flush on any line