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Med Surge 1 - Exam 1 > Central Lines & TPN > Flashcards

Central Lines & TPN Flashcards

1
Q

A central venous device is placed into the venous system and threaded into a ___ ___.
Is it usually superior or anterior?

A
  • vena cava

- superior

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2
Q

When is the inferior vena cava used?

A

when access is gained through the femoral vein –> emergency

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3
Q

What are 5 indications for placement of a central venous catheter?
What should be considered for this therapy?

A
  • IV fluids : long/short term, poor venous access, emergency
  • Chemotherapy / irritating drugs
  • hemodynamic monitoring
  • venous blood sampling : poor venous access
  • parenteral nutrition
  • you should consider if the benefits out weight the risks, and continue to assess this frequently
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4
Q

What are the 4 types of central lines?

Can you go home with them?

A
  • non tunneled catheter : short term –> cannot go home with this
  • tunneled catheter : can go home
  • PICC line : can go home
  • implanted port : can go home
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5
Q

More lumens = __ (larger or smaller) line = __ (inc or dec) risk fo infection

A

more lumens = larger line = inc risk for infection

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6
Q

Can you give medications that are not compatible is separate lumens of the same line?

A

Yes - each lumen has its own individual line

–> should not give at the same time

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7
Q

PICC line

  • __ (inc or dec) risk form pneumothorax? Why?
  • __ (inc or dec) risk fo SVT / DVT?
A
  • dec risk for pneumothorax b/c inserted into the arm

- inc risk for SVT/DVT in the arm where the line is placed

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8
Q

When can a PICC line be uncovered?

Are dressing changes for PICC lines clear or sterile? How often should we change the dressing?

A
  • should always be covered, will immediately replace dressing during dressing change
  • sterile dressing change
  • change dressing every 7 days or PRN
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9
Q

What type of central line has the highest risk for infection?

A

non tunneled central line

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10
Q

Where can a non tunneled central line be inserted?

A
  • into the jugular vein

- into the subclavian vein

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11
Q

Describe the placement of a tunneled central line

Why is this type of placement beneficial?

A

entry site is further from the venous system, it is threaded through Sub Q tissue and then enters the subclavian vein, and is threaded to the superior vena cava
- this is beneficial because the line does not directly enter the blood –> dec risk of infection

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12
Q

When is a non tunneled central line typically placed?
large or small bore?
How long can it remain in place?
Is care for the insertions site clean or sterile?

A
  • emergency
  • large bore –> increases the risk for infection
  • no standard for how long it can stay in but should be removed ASAP bc of high infection risk
  • STERILE
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13
Q

Describe the dressing care for a tunneled CL

A
  • dressing for the first 10 days after placement
  • after 10 days can wash with soap and water
  • should inspect daily for s/s of infection
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14
Q

Describe the placement of an implanted port

A

lumen(s) is placed in a subQ pocket under the skin in the chest, the catheter then enters the vein and is threaded into the vena cava

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15
Q

How is the lumen of an implanted port accessed?

What should be done for infection control after the lumen has been accessed?

A
  • need a special needle to puncture the reservoir and install the medication
  • the port should be covered after it has been accessed
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16
Q

What are 9 risks of having a central line?

A
  1. CLABSI : central line associated blood stream infection
  2. bleeding : after insertion (not during)
  3. arrhythmias : typically the catheter is too far and tickling the atria
  4. occlusion
  5. dislodgment
  6. migration
  7. air emboli : esp when taking out
  8. pneumothorax : esp subclavian non tunneled
  9. thrombosis : mc with PICC lines
17
Q

What is the max lbs/in^2 a central line can tolerate?

B/c of this we should use a __ (large or small) syringe?

A
  • max is 25 lbs / in^2

- should use a large syringe –> never less than 10 mL

18
Q

What if pharmacy sends a medication to be administered via central line in a 5 mL syringe?

A

Ensure the line is flushing REALLY well, give the medication, flush with an appropriate size syringe after med administration

19
Q

What is TPN?
What is the mixture made of?
What needs to be added in addition to TPN to have total parenteral nutrition?

A
  • TPN = parenteral nutrition
  • mix of : amino acids, electrolytes, and dextrose
  • total parenteral nutrition = TPN + lipids
20
Q

What type of line is required for TPN?

Can it be administered though a line that is also being used for medication administration?

A
  • only administered through a central line

- needs to have its own lumen : the only thing it can be infused with is lipids

21
Q

What are the 2 general indications for TPN?

Who decides how much for how ling and content?

A
  • indications : (1) pt does not have a function GI tract, (2) pt needs complete bowel rest
  • nutrition decided the content, time, and amount
22
Q

What are the risks associated with TPN? (6)

A
  1. infection : central line AND high dextrose content
  2. hyperglycemia : check CBG regularly
  3. hypoglycemia : abrupt cessation / come off
  4. liver failure : lipids are not given
  5. fluid overload
  6. referring syndrome : in pts who are severely malnourished –> feed too much too fast (can kill them)
23
Q

You should titrate/wean TPN based on __ __.

A

institution policy

24
Q

If a pt is on TPN and insulin, and you stop the TPN should you continue or stop the insulin?

A

you should stop the insulin so the pt does not become hypoglycemic –> TPN has a high dextrose content which may require insulin to control blood glucose

25
Q

How long can you hang TPN?
What size filter does it need?
What else does the line need?

A
  • can hang for 24 hrs
  • nees a 0.22 micron filter
  • line also needs to be labeled
26
Q

How long can you hang lipids?

What size filter should be used with lipids?

A
  • can be hung for 12 hrs

- need a 1.2 micron filter

27
Q

What types of pts would not receive lipids with TPN? (4)

A
  • obese
  • high triglycerides
  • acute pancreatitis with hyperlipidemia
  • receiving propofol

Med Surge 1 - Exam 1 (6 decks)

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