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sav nur 334 exam 2 > Central Venous Catheter Care > Flashcards

Central Venous Catheter Care Flashcards

1
Q

4 reasons a patient may need a CVC

A

TPN, chemotherapy, longterm antibiotic use, loss of peripheral access

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2
Q

What determines whether a line is peripheral or central?

A

the location of the tip of the catheter (NOT the insertion site)

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3
Q

Veins used for non-tunneled CVC (“deep lines”)

A

Subclavian (SC), internal jugular (IJ)

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4
Q

3 Types of tunneled CVCs

A

Hickman, Groshong, and Broviac

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5
Q

Two other names for implanted ports

A

“Portacaths” and “PowerPorts”

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6
Q

Location of tip of peripherally-inserted central catheter

A

Right atrium or superior vena cava

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7
Q

A primary bloodstream infection that develops in a patient with a central line in place within the 48-hr period before the onset of blood stream infection that is not r/t an infection from another site is called a

A

Central Line-Associated Blood Stream Infection (CLABSI)

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8
Q

TRUE or FALSE: The RN may run 3 incompatible drugs through a triple lumen deep line.

A

TRUE

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9
Q

What is a risk of placing deep line in subclavian

A

pneumothorax

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10
Q

The ____________ prevents atmospheric air from entering the large vessel during the removal of a non-tunneled CVC.

A

Valsalva Maneuver

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11
Q

Advantage of a tunneled CVC compared to imported plant

A

No needle sticks required

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12
Q

Disadvantage of a tunneled CVC

A

Prolonged break in skin integrity

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13
Q

Who removes a tunneled CVC?

A

the HCP

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14
Q

The needle used to access an implanted port is called

A

a non-coring (‘Huber’) needle

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15
Q

Primary complication of implanted port

A

Catheter occlusion

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16
Q

2 Advantages of PICC

A

Less microorganisms on arm

Less insertion complications such as pneumothorax

17
Q

True or False: The RN may remove a PICC?

A

TRUE

18
Q

Describe how the RN will remove a PICC.

A

Have patient lie or sit down/hold hand below level of heart & bear down while withdrawing - withdraw inch-by-inch, relaxing catheter after each inch; do NOT pull catheter if vein spasms; measure length of catheter.

19
Q

How often must the access needle be changed for an implanted port with continuous IV fluids?

A

Weekly

20
Q

non-tunneled/deep lines

_____________ CVC
- Could accidentally nick lung and cause pneumothorax
- Less movement issues
________________CVC
- Nuisance bc of placement on neck – neck is very mobile and moist
- No risk of lung puncture

A
  • Subclavian CVC
  • Could accidentally nick lung and cause pneumothorax
  • Less movement issues
  • Internal jugular CVC
  • Nuisance bc of placement on neck – neck is very mobile and moist
  • No risk of lung puncture
21
Q

tunneled or non-tunneled

  • Inserted by HCP, Removed by RN
  • 1-5 ports
  • 7-10 inches long
  • Tip is in superior vena cava (enters through _______ or _______)
  • CXR post procedure – bc of risk of pneumothorax
  • No recommended dwell time
  • Short term use – emergency, trauma, critical care, surgery
  • Not for home/ambulatory clinic setting
A

non-tunneled
enters through subclavian or internal jugular vein)

22
Q

non-tunneled or tunneled

-Complications:
- Bleeding at site
- Air embolus
- Pneumothorax
-Dressing includes:
- The stat lock is there to stabilize so skin hole doesn’t get bigger and allow bacteria to get in easier
- The algidex/bio patch is there to prevent CLABSI

A

nontunneled IJ and SC

23
Q

non-tunneled or tunneled

-Removed by RN
- Check INR if on anticoags (International Normalized Ratio - test used to measure the clotting time of blood. It is primarily used to monitor patients who are taking blood thinners, such as warfarin, to prevent blood clots.) – to make sure they wont have bleeding issues when removed
- Supplies:
- Sterile suture removal kit
- Sterile and clean gloves
- Occlusive dressing
- Measuring tape – make sure as much came out as went in, length of catheter is documented in chart

-Explain procedure:
- Supine or Trendelenburg
- Valsalva – hum or bear down, prevents atmospheric air from being sucked into the big vessel when CVC is being pulled out
- Apply pressure for 3-5 mins
- Apply occlusive dressing
- May need to culture tip of catheter

A

nontunneled

24
Q

tunneled vs nontunneled

  • Provides more stability, less movement = less likely to get pulled out
  • Placed in OR, removed by HCP
  • Trade names – named after physician who invented them
  • Broviac, hickman, groshong
  • Used when infusion therapy is frequent and prolonged (even years)
  • Adv - Doesn’t require needle sticks (implanted ports do)
  • Disadv – prolonged break in skin integrity (implanted ports do not)
  • Irrigation protocol varies – may require heparin
  • Site care required

-Complications
- Catheter damage
- Occlusion
- Thrombosis
- Sepsis

A

tunneled

25
Q

which CVC

  • No tubing involved – least impact on body image
  • Requires huber needle to access port
  • Chest port wears out after 2000 punctures
  • Upper arm port wears out after 750 punctures
  • Placement in OR, Surgically implanted – catheter attached to a port which is placed in a pocket made in SQ tissue on chest wall
  • Post procedure – incision is closed
  • For pts that require IV therapy > a year
  • Considered semi permanent
  • Site care – only when accessed
  • Change access needle weekly
  • Requires Cleaning and dressing
  • Complications – catheter occlusion
  • Removed by HCP – must make incision to remove port
A

implanted port

26
Q

which CVC

  • 8-10 inches long
  • Threaded up peripheral vessel into big vein
  • Placed at bedside by certified RN, HCP, or radiologist
  • Duration 3-12 mos
  • Placed at bend of elbow
  • No BP or blood draws on this arm – risk of impairing the fusion and damaging the site
  • Lower complication rates than CVC
  • Since its not going on the neck No issues with neck mobility
  • Less microorganisms on arm
  • Less insertion complications - No risk of lung puncture (pneumothorax)
  • Irrigation required
  • Site care required
  • removed by RN
A

PICC - non-tunneled

27
Q

which CVC

-Site care required
- Swabbing caps with alcohol
- Dressing changed
- day after insertion
- every Wednesday
- when soiled

-removed by RN
- pt lie down or sit down
- hand below level of heart
- bear down while withdrawing
- withdraw slowly
- do not pull catheter if vein spasms
- measure length of catheter (cm)

A

PICC

sav nur 334 exam 2 (16 decks)

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