Central Venous Access Flashcards
Patient selection
Short or long-term therapy (anybody >5 days needs CVA of some sort).
Blood sampling (poor vascular access and frequent blood draws).
Multiple therapies.
Venous access sites.
Vesicant administration.
In order for something to be a CVAD, despite where if enters the body, the tip of the catheter must sit in the lower 1/3 of the _______ at the caval-atral junction.
Superior vena cava
Pediatric catheter insertion sites
Temporal or auricular, but otherwise same vascular access as adults just use small catheters
Classifications of CVA catheters
1) Central venous catheters- tunneled or non tunneled
2) ports
3) Peripherally inserted central catheters
Nontunneled catheters
Subclavian catheter. Jugular placement possible too. Short-term device intended to be used for several days and primarily placed and used in an acute care setting. Single-or multiple-lumen.
Epidural catheter
When cleaning, cannot use anything with alcohol in it. Alcohol can leak along the tract. Non-permanent or permanent (tunneled). Pain relief. Always have to have a filter.
Tunneled catheters
Hickman, Broviac, Groshong. Need for prolonged CVA and a method to decrease potential infection from the skin exit site. Considered long-term catheter for pts who require lifelong or long-term infusion therapy such as PN or chemo. Under muscle into vessel (subclavian).
Hickman catheter
Single, double, triple, quad lumens. Open-ended cath. Flushed daily. Need to be clamped (“clamp here” area).
Broviac catheter
Size of line in body smaller than in hickman. Flush daily. Peds or small people
Groshong catheter
Have valves- if not in use, closed. Infusing, open out. Drawing in, open in. Don’t need heparin. Good flushing! Every 7 days. Only flushed when used=decrease cost
Ports
Kids, breast/colon cancer, meds every 4-6 weeks. Under skin- make pocket, thread thru skin to subclavian vein then SVC. Access with Huber needle (noncoring needle). Long-term. Single and double lumen. Only accessed and flushed every 4-6 weeks. Under skin so no care when not accessed. Sutured to rib. Deaccess and reaches making sure you are at a 90 degree angle to the port, not a 90* angle to the pt, and you feel the back of the port.
Power port
Use for injection of dye for MRI, CT. Forces in so it dissipates quickly. Can handle the force of fast injection of the material. Knobs to access landmarks. Triangular. Need to wear an armband, have a wallet card for identification of it. Not to be used to administer other medications. Purple=power
Never give anything in a catheter that you cannot easily withdraw ___ to ___ mL of blood because you do not have a patent catheter
3-5
90% of VADs today. Best place to put is on the right side because there is a steeper angle on the left side and it can injure the vessel wall. Preferred place is basilica vein. Designed for infusion therapies extending beyond 6 days to several months.
PICC (peripherally inserted central catheter).
Want catheters in a vessel large enough to _____ whatever you are giving and to minimize damage to the vessel wall
hemodilute
Flushing standard
VADs shall be flushed at established interval. To promote and maintain patency. To prevent mixing of medications and solutions that are incompatible.
Purpose of flushing
To reduce the incidence of catheter related blood stream infection by preventing or reducing the development of biofilm.
Flushing technique
Scrub the hub. Flush the catheter. Clamp the line. Remove the syringe.
CVAD removal
Should be removed when it is no longer needed. Potential cx associated with CVAD removal include air embolism, catheter embolism, and excessive bleeding. Never pull against resistance because catheter breakage or vein wall damage can occur. If resistance is encountered: use a warm compress to dilate the vein proximal to the exit site. Use of relaxation techniques. Hand and arm exercises. Reattempt removal after short or intermediate time period
Assessment before consideration of CVAD placement in a pt should include which of the following? (SATA)
a) Vascular integrity
b) Expected duration of therapy
c) Pt preference r/t lifestyle
d) Health history
a) Vascular integrity
b) Expected duration of therapy
c) Pt preference r/t lifestyle
d) Health history
An indication for placement of a CVAD is:
a) medication with a pH of 5
b) medication with a pH of 12
c) solution with an osmolarity of 500 mOsm/L
d) solution with an osmolarity of 300 mOsm/:
b) medication with a pH of 12
Maximal sterile barrier precautions implemented with CVAD insertion include wearing:
a) a mask, sterile gloves, a gown, and foot covers
b) a cap, a mask, sterile gown, and sterile gloves
c) sterile gloves, a gown, and foot covers
d) a mask and sterile gloves
b) a cap, a mask, sterile gown, and sterile gloves
The most desirable vein for PICC insertion is the:
a) cephalic
b) basilic
c) brachial
d) Median cubital
b) basilic
An advantage to the subcutaneously tunneled catheter is:
a) low cost
b) improved body image
c) ease of removal by the nurse
d) decreased risk for bloodstream infection
d) decreased risk for bloodstream infection
An important risk associated with the procedure of CVAD removal is
a) bloodstream infection
b) catheter-associated venous thrombosis
c) Nerve damage
d) Air embolism
d) Air embolism
Implanted ports, when not in use, are locked (flushed):
a) monthly
b) weekly
c) every 3 weeks
d) every 2 months
a) monthly
Advantages of the TSM dressing include:
a) it is changed every 3 days
b) it is easier to visualize the site
c) it covers up any perspiration
d) patient preference
b) it is easier to visualize the site
Chlorhexidine-impregnated dressings should be considered for use:
a) in organizations with high infection rates
b) on all subcutaneously tunneled CVADs
c) on all PICCS
d) with home care pts
a) in organizations with high infection rates
Potential risks associated with withdrawal of blood through the CVAD include:
a) patient anxiety
b) Increased risk for catheter occlusion
c) patient dissatisfaction
d) catheter dislodgement
b) Increased risk for catheter occlusion