Advanced Skills IV Theory (Exam Two) Flashcards
What is the primary concern or complication of placing a peripherally inserted central line catheter (PICC) in the subclavian vein?
Puncturing the lung/collapsing the lung
What are the signs and symptoms of lung puncture?
- Chest pain
- SOB
- Elevated respiratory rate
- Tachycardia
- Low O2
- Cyanosis
Why is the femoral vein not an ideal location for central line placement?
High risk of infection
Where does the tip of a peripherally inserted central line catheter (PICC) end once inside of the body?
Lower one-third of superior vena cava (top of the heart)
List the therapeutic indications for central venous catheter (central line) placement.
- Prescribed therapy (medication)
- Expected duration of therapy
- Health history
- Vascular integrity (condition of veins)
- Device availability
What types of medications should only be infused through a central line catheter?
-Highly vesicant medications
Why should the nurse or doctor be cautious in placing a peripherally inserted central line catheter (PICC) in a patient with end stage renal failure?
The PICC line eliminates a potentially good vein to place a dialysis port due to scarring of the vein
Why might a patient with end stage renal failure have a central line placed?
Due to an immediate need for dialysis
Fistulas and grafts must be what before they can be utilized to delivery therapy?
Mature
How long does it take a fistula or graft to mature?
Three to six months
The patient may not be considered a viable candidate for a central line placement if what medical condition is listed within their health history?
Renal disease/impairment
The nurse should be concerned with vascular integrity of what types of patients?
- Drug users
- Chemotherapy
- Chronic illness (who have had multiple/repetitive IV’s)
Why might a medical professional be hesitant to give a patient who currently abuses drugs a central line?
May attempt to inject drugs through the port
What are the most common uses of a central line catheter?
- Chemotherapy
- Total parenteral nutrition
- Long-term medication therapy
- Long-term blood sampling
After drawing blood from a central line port, how many mL of NS should be used to flush the tubing?
10mL to 20mL
What is the minimum size of syringe that can be used with a central line?
10mL
Prior to drawing blood out of a central line, when should the nurse stop the medication that is currently infusing?
10 minutes prior to drawing the patients blood
What is the smallest gauge of needle that can be used for a central line?
20 gauge
If not being utilized, the central line catheter should be what?
Clamped
Why should any port on a central line that is not in use be clamped?
To avoid possible occlusion
What should be placed on a central line that is not infusing as a standard of practice?
Alcohol soaked caps
What is the most common type of central line?
Peripherally inserted central line catheter (PICC)
Who is able to insert or place a PICC line?
- Physicians
- Skilled nurses
What devices are inserted for short-term access?
- Non-tunneled CVC
- PICC line
- Midline catheter
What is a midline catheter?
Similar to a PICC line, but the catheter tip ends at or near the axilla
A non-tunneled CVC is inserted into which vein?
Subclavian vein
What position must the patient be placed in when inserting a non-tunneled CVC?
Supine or Trendelenburg
When and why is the valsalva maneuver utilized during central line catheterization?
- Used during the needle stick
- Decreases the risk of air embolism
How long is a non-tunneled CVC good for?
7 to 10 days
What must be obtained before beginning infusion on a non-tunneled CVC? Why?
Chest x-ray to verify correct placement
What medical personnel is capable of removing a central line?
- Nurses (as long as competent and trained)
- Physicians
What maneuver must be used when removing a central line?
Valsalva
How long can a PICC line remain inserted and be utilized?
Up to one year
What is the best site to insert a PICC line?
Basilic vein
List the advantages of a PICC line?
- Location of insertion (eliminates insertion risk of pneumothorax)
- Eliminates most peripheral sticks
- Cost effective
- Time efficient
- Home care availability
- Lower risk of infection
- Appropriate for all ages
A patient needs IV antibiotics for six weeks to be administered at home, what type of central line is most appropriate for this type of therapy?
Peripherally inserted central line catheter (PICC)
List the disadvantages of a PICC line?
- Possible bruising
- One hour insertion
- Special training required for insertion
- Daily or weekly care
- Removes viable option for dialysis
- Potential for vein thrombosis
PICC lines are contraindicated for patients with what types of conditions?
- Lifestyles involve being in water
- Pre-existing skin infection of arms
- Anatomic distortions related to injury
- Coagulopathies
What lab values should the nurse assess before inserting a PICC line?
Coagulation factors
Solutions should not be _______ into a PICC line.
Forced
Regarding any central line, once the patient has completed their entire course of therapy, what should happen to the central line? Why?
It should be removed to avoid infection
List long term central venous access devices.
- Tunneled catheters
- Implanted ports
How long are central venous tunneled catheters intended for use?
Months to years
What solutions or fluids can be administered through a central venous tunneled catheter?
- Hypertonic solutions
- Blood
- Medications
- Parenteral nutrition
How are central venous tunneled catheters inserted?
Surgically
Describe non-tunneled catheters.
Enters directly into the vein
Describe tunneled catheters.
Tunnels underneath the skin before entering the vein
What is less likely to occur if a patient has an implanted port?
Infection
What type of needle is used to access an implanted port?
Huber needle
Describe a huber needle?
Non-coring needle
Implanted ports are commonly mistaken for what?
Pacemakers
How often must an implanted port be flushed, even if it is not in use?
Every one to two months
The procedure used to access an implanted port is what? Explain.
- Sterile
- Mask is needed for nurse and patient, nurse must don sterile gloves
What solution is used to flush an implanted port?
500 units/5 mL of heparin
Why is it important for an implanted port to remain heparin flushed and locked?
To prevent blood clots in the tube
Who can insert an implanted port? Who can access/deaccess and implanted port?
- Physician must insert
- Nurse may access or deaccess
What type of therapy are implanted ports commonly used for?
Chemotherapy
Implanted ports are more likely to ______ if not flushed properly.
Occlude
It may be ___________ to access an implanted port.
Painful
A systemic infection affects what part of the body?
Entire body system
A local infection affects what part of the body?
One central or localized area on the body
What vital sign changes will a patient exhibit if they are becoming septic?
- Decreased blood pressure
- Increased heart rate
- Increased temperature
What type of complication is a hematoma?
Local
List the signs and symptoms of a hematoma.
- Discoloration of skin
- Site swelling
- Site pain
- Inability to advance cannula
- Resistance during flushing
What are the treatment options for a hematoma?
- Apply direct, light pressure
- Elevate extremity
- Apply ice
What may happen if extreme pressure is applied to a hematoma?
Too much force for a prolonged period of time will cause circulation issues
What type of complication is phlebitis/thrombophlebitis?
Local
What are the causes of phlebitis/thrombophlebitis?
- Chemical damage
- Mechanical vein trauma
- Bacteria
List the signs and symptoms of phlebitis/thrombophlebitis.
- Erythema at the site
- Pain at site
- Local swelling
What are the treatment options for phlebitis/thrombophlebitis?
- Apply warm compress
- Elevate limb
- Analgesics or anti-inflammatory agents as needed
Does the peripheral IV always have to be changed if phlebitis occurs? Explain.
- Not always
- Phlebitis that occurs without any reason will likely require the IV to be changed
What is the difference between infiltration and extravasation?
Type of IV fluid that leaks into the surrounding tissue
What is infiltration?
Cannula is no longer in the vein and regular/maintenance fluid goes into the surrounding tissue