complications assoc w CVCs fraser health

Question 1

what is the most dealy complication assoc w CVC and when can it occur

Answer 1

An AIR EMBOLISM is potentially the most deadly complication associated with CVC’s. It can occur as the catheter is inserted, but the risk of air embolism is present as long as the catheter is in situ.

Question 2

is it the amount or the speed with which air enters that inc the risk

Answer 2

It appears it is the speed with which air enters the system, rather than the amount that increases the risk

Question 3

complications assoc with insertion

Answer 3

Cardiac Dysrhythmias
Pneumothorax
Bleeding
Hematoma
Hemothorax.

Question 4

3 most common complications of CVADs

Answer 4

air embolism
infection
occlusion

Question 5

other complications of CVADS

Answer 5

Air Embolus
♦
Catheter Dislodgment
♦
Pulmonary embolus
♦
Infection
♦
Device Malfunction
♦
Venous Thrombosis
♦
Occlusion
♦
Perforation
♦
Catheter tip migration
♦
Extravasation
♦
Phlebitis
♦
Broken or damaged

Question 6

how to prevent air embolus

Answer 6

♦
Ensure the lumen is clamped prior to opening the system
♦
Keep a blue clamp or padded forcep with patient in case of catheter breakage
♦
Use Luer lock connections
♦
Having patient perform Valsalva maneuver (forcible exhalation against a closed glottis) when risk of air embolism is high
♦
Position the patient so that the insertion site is at or below the level of the heart during insertion and removal of catheter

Question 7

s/s of air embolus

Answer 7

CNS changes: altered neurological signs, dizziness, confusion, loss of Consciousness
♦
CVS changes: sudden onset of chest pain, ↑HR, ↓BP, no BP,
♦
Respiratory changes: sudden shortness of breath, cyanosis

Question 8

tx of air embolism

Answer 8

♦
Positioning the patient on their left side in Trendelenberg (if not contraindicated by other conditions such as increased intracranial pressure or respiratory diseases)
♦
Clamp the Central Venous Catheter (between the patient and air if possible)
♦
Initiate cardiac and respiratory resuscitation measures as needed and notify the physician

Question 9

what is the most common compliction of CVC

Answer 9

infection from the flora on skin

Question 10

what type of infusion inc risk of infection a lot

Answer 10

parenteral nutrition

Question 11

what complic if nt dealt with dramatically inc the risk of infection

Answer 11

CVCs occluded for >24 hours increase the patient’s risk of infection exponentially! Treat blocked CVCs AS SOON AS POSSIBLE!

Question 12

thrombotic occlusions make up 58% of occlusions. what else causes occlusions

Answer 12

non thrombotic obstr eg drug precipitates, lipid deposits, mechanical obstr

Question 13

what to do if catheter is partially or completely blocked from drug precipitate or lipid depositis

Answer 13

contact dr for instruction

Question 14

what to do/expect if infection

Answer 14

•
Aseptic technique with site care, tubing changes, etc.
•
Notify physician
􀂃
Swab insertion / exit site if it appears infected and send for C&S
•
If ordered, Blood Cultures will need to be sent from each lumen (see pg 59)
•
Send tip for culture if CVC removed
•
Remove catheter only as last treatment of choice!

Question 15

early sign of occlusion

Answer 15

Early sign - ability to infuse fluids, but the inability to

aspirate blood

Question 16

what to do if theres occlusion

Answer 16

Use only positive displacement caps for locking
•
Routine flushing, especially between meds and blood draws
•
Do not attempt to clear blockage by forceful flushing
•
Thrombolytic therapy to unblock CVC by Competency Assessed RN with a Physician’s Order
•
Remove the catheter on Physician’s Order if not salvagable

Question 17

interventons for asymptomatic pt who has potential for air embolism

Answer 17

Immediately clamp catheter as close to patient’s skin as possible
•
Position flat
•
Aspirate air, change IV set-up, flush and reconnect system prn

Question 18

pt has air embolism what do

Answer 18

•
Immediately clamp catheter proximal to patient
•
Position patient on left side Trendelenberg
•
Initiate resuscitative measures
•
Obtain help & call physician “STAT”

Question 19

what to do if you have pinch off syndrome or the catheter ruptures from excess flushing P

Answer 19

Always check device for any signs of

damage (e.g. cracks or leaks)

Question 20

what to do if catheter device malfunction due to external causes such as

-Improper clamping, Use of scissors or other sharp objects, Use of needles through the injection cap•
Constant moving and bending of elbow/shoulder in PICCs, “Twiddler’s syndrome

Answer 20

Prepare for insertion of a new catheter by physician
•
Temporary or permanent repair is possible in some catheters including PICCs and tunneled CVCs. Call General Daycare or Home IV RN

Question 21

what to do if partial catheter dislodgement

Answer 21

If partial dislodgment:

• stabilize catheter
• decrease rate to TKVO
• change solution to normal saline
• position patient flat
• notify physician

Question 22

wht do if catheter is completely dislodged and pt is asymptomatic

Answer 22

apply P to site
Asymptomatic:
- position patient flat
- apply pressure x 5 minutes, then
pressure dressing
- monitor for S&S of air embolism
- notify MD

Question 23

what do if catheter is completely dislodged and pt is symptomatic

Answer 23

Symptomatic:

• position patient on left side Trendelenberg
• initiate resuscitative measures as necessary
• obtain help & call Physician “STAT”
• continue to apply pressure for 5 minutes

Question 24

what is a central vein perforation

s/s

Answer 24

Rare complication associated
with left sided insertion

-Symptoms relate to site of
perforation, commonly the
pericardial sac & pleural
cavities
-Most common symptom is
dyspnea

Question 25

intervention central vein perforation

Answer 25

•
Assess patient post insertion
•
Apply O2
•
Notify Physician ‘STAT’ if not at bedside
•
Initiate cardio pulmonary
resuscitation as necessary

Question 26

hich type of CVC can have moist heat and when

Answer 26

a PICC for phlebitis

Question 27

interventions for phlebitis

Answer 27

•
Eliminate irritating infusion
•
Remove catheter, if ordered
•
Moist heat for PICCs only
•
Antibiotic therapy
•
Elevate extremity if PICC

Question 28

when does pneumothorax generally appear

Answer 28

Accumulation of air in the pleural cavity – often associated with insertion technique
Increased incident during
placement of a subclavian
catheter

Question 29

s/s of pneumothorax

Answer 29

Dyspnea
•
Cyanosis
•
Chest pain
•
Pain behind clavicle
•
Hypotension
•
Tachycardia
•
Asymmetrical chest movement
•
Decreased/absent breath sounds

Question 30

nursing interventions for pneumothorax

Answer 30

Vital signs post insertion
•
Chest x-ray post insertion
•
Assess bilateral breath sounds
•
Apply 02 to maintain SaO2 > 92%
•
Elevate head of bed to 45°
•
Call Physician “STAT”
•
Prepare for possible chest tube insertion

Question 31

incidence of venous thrombosis

s/s

Answer 31

VENOUS THROMBOSIS
Rare 1-16% of CVCS
May occur with short or long-term catheters

Arm or neck swelling
•
External jugular distension
•
Pain
•
Numbness
•
Weakness on affected side

Question 32

nursing interventions for venous thrombosis

Answer 32

•
Observation
•
Removal of catheter on physician’s order
•
Long-term anticoagulation (3-6 months)
•
Thrombolytic therapy