Complex lines/ Medication administration Flashcards
List the fluid infusion routes:
Fluid infusion routes
- subcutaneous
- epidural
- intravenous
o Peripheral (PVC)
o Central (CVC)
o Peripherally inserted central line (PICC)
- continuous, intermittent,
- intraosseous
What is an epidural?
Epidural
- local anaesthetic into epidural space
- blocks spinal nerve roots in epidural space & sympathetic nerve fibres adjacent
- effective for labour, childbirth, post c-section, thoracic for chest injuries
What is an Intraosseous (I/A)
Intraosseous (I/O)
- directly into marrow of a bone
- usually proximal tibia, humerus
- effective for fluid & blood replacement & drug delivery
- indications
o circulatory access in cardiac arrest
o decompensated shock where other IV attempts fail
o Exception = newborn *umbilical vein
What is a central venous catheter (CVC?
= central vein into a central spot
— tip near right atrium or a large central vein
— single or multiple lumen
— each lumen independent and ends at diff levels
— CVC institute 4 X longer than PIVC
What are the indications for a CVC?
Indications for CVC
- Fluid/ blood products
- monitoring hydration status
- monitoring cardiac status
- monitoring effects of cardio active drugs e.g inotropes
- administration of hazardous medications
- parental nutrition
- haemodialysis
What are the complications of CVC?
CVC complications
- bleeding
- infection / sepsis
- blocked lines, thrombus
- air embolism
- hypothermia
- arrhythmias
Where are CVC insertion sites?
CVC insertion sights:
- subclavical vein —> longer term use due to less vessel irritation
- Internal or external jugular —> less complications
What is a PICC?
= into a central vein from a peripheral area
- usually long term use
- insertion sites: cephalon, basilic, brachial, femoral
- Risk of
o pneumothorax
o vessel peroration
o infection
What are the nursing responsibilities with CVC?
Nursing responsibilities
Initial
- explain procedure / gain consent
- cardiac monitoring/ patient observations
- position patient
- securing central line
- documentation
Ongoing
- dressing
- fluids
- removal
- site inspection
- infusions ALWAYS through pump
What is Central venous pressure?
CVP
Central Venous pressure (CVP) monitoring
- normal range 2-8mmhg
- direct measurement of pressure in RA
- Why monitor?
- abnormalities cause by altered venous tone, blood volume or ventricular contractility
What are access ports?
Access ports:
- surgically implanted port beneath skin
- usually inserted in upper chest/ arm
- Uses:
- haem/ onc
- haemodialysis
- pts requiring long term medications
What are arterial lines?
= monitor continuous BP & reg ABG
Arterial line
- intra-arterial monitoring for BP
- continuous & accurate
- insertion points
- radial artery
- femoral artery
indications for art lines?
Indications: unstable patients, vasoactive medication, hypo/ hypertensive, frequent ABGs
Complication with Art lines?
Complications: Air embolism, haemorrhage, thrombosis, infection/ sepsis
