complications assoc w CVCs fraser health Flashcards
what is the most dealy complication assoc w CVC and when can it occur
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.
is it the amount or the speed with which air enters that inc the risk
It appears it is the speed with which air enters the system, rather than the amount that increases the risk
complications assoc with insertion
Cardiac Dysrhythmias Pneumothorax Bleeding Hematoma Hemothorax.
3 most common complications of CVADs
air embolism
infection
occlusion
other complications of CVADS
Air Embolus ♦ Catheter Dislodgment ♦ Pulmonary embolus ♦ Infection ♦ Device Malfunction ♦ Venous Thrombosis ♦ Occlusion ♦ Perforation ♦ Catheter tip migration ♦ Extravasation ♦ Phlebitis ♦ Broken or damaged
how to prevent air embolus
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Ensure the lumen is clamped prior to opening the system
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Keep a blue clamp or padded forcep with patient in case of catheter breakage
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Use Luer lock connections
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Having patient perform Valsalva maneuver (forcible exhalation against a closed glottis) when risk of air embolism is high
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Position the patient so that the insertion site is at or below the level of the heart during insertion and removal of catheter
s/s of air embolus
CNS changes: altered neurological signs, dizziness, confusion, loss of Consciousness
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CVS changes: sudden onset of chest pain, ↑HR, ↓BP, no BP,
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Respiratory changes: sudden shortness of breath, cyanosis
tx of air embolism
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Positioning the patient on their left side in Trendelenberg (if not contraindicated by other conditions such as increased intracranial pressure or respiratory diseases)
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Clamp the Central Venous Catheter (between the patient and air if possible)
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Initiate cardiac and respiratory resuscitation measures as needed and notify the physician
what is the most common compliction of CVC
infection from the flora on skin
what type of infusion inc risk of infection a lot
parenteral nutrition
what complic if nt dealt with dramatically inc the risk of infection
CVCs occluded for >24 hours increase the patient’s risk of infection exponentially! Treat blocked CVCs AS SOON AS POSSIBLE!
thrombotic occlusions make up 58% of occlusions. what else causes occlusions
non thrombotic obstr eg drug precipitates, lipid deposits, mechanical obstr
what to do if catheter is partially or completely blocked from drug precipitate or lipid depositis
contact dr for instruction
what to do/expect if infection
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Aseptic technique with site care, tubing changes, etc.
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Notify physician
Swab insertion / exit site if it appears infected and send for C&S
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If ordered, Blood Cultures will need to be sent from each lumen (see pg 59)
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Send tip for culture if CVC removed
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Remove catheter only as last treatment of choice!
early sign of occlusion
Early sign - ability to infuse fluids, but the inability to
aspirate blood
what to do if theres occlusion
Use only positive displacement caps for locking
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Routine flushing, especially between meds and blood draws
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Do not attempt to clear blockage by forceful flushing
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Thrombolytic therapy to unblock CVC by Competency Assessed RN with a Physician’s Order
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Remove the catheter on Physician’s Order if not salvagable
interventons for asymptomatic pt who has potential for air embolism
Immediately clamp catheter as close to patient’s skin as possible
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Position flat
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Aspirate air, change IV set-up, flush and reconnect system prn
pt has air embolism what do
• Immediately clamp catheter proximal to patient • Position patient on left side Trendelenberg • Initiate resuscitative measures • Obtain help & call physician “STAT”
what to do if you have pinch off syndrome or the catheter ruptures from excess flushing P
Always check device for any signs of
damage (e.g. cracks or leaks)
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
Prepare for insertion of a new catheter by physician
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Temporary or permanent repair is possible in some catheters including PICCs and tunneled CVCs. Call General Daycare or Home IV RN
what to do if partial catheter dislodgement
If partial dislodgment:
- stabilize catheter
- decrease rate to TKVO
- change solution to normal saline
- position patient flat
- notify physician
wht do if catheter is completely dislodged and pt is asymptomatic
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
what do if catheter is completely dislodged and pt is symptomatic
Symptomatic:
- position patient on left side Trendelenberg
- initiate resuscitative measures as necessary
- obtain help & call Physician “STAT”
- continue to apply pressure for 5 minutes
what is a central vein perforation
s/s
Rare complication associated
with left sided insertion
-Symptoms relate to site of perforation, commonly the pericardial sac & pleural cavities -Most common symptom is dyspnea
intervention central vein perforation
• Assess patient post insertion • Apply O2 • Notify Physician ‘STAT’ if not at bedside • Initiate cardio pulmonary resuscitation as necessary
hich type of CVC can have moist heat and when
a PICC for phlebitis
interventions for phlebitis
• Eliminate irritating infusion • Remove catheter, if ordered • Moist heat for PICCs only • Antibiotic therapy • Elevate extremity if PICC
when does pneumothorax generally appear
Accumulation of air in the pleural cavity – often associated with insertion technique
Increased incident during
placement of a subclavian
catheter
s/s of pneumothorax
Dyspnea • Cyanosis • Chest pain • Pain behind clavicle • Hypotension • Tachycardia • Asymmetrical chest movement • Decreased/absent breath sounds
nursing interventions for pneumothorax
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
incidence of venous thrombosis
s/s
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
nursing interventions for venous thrombosis
• Observation • Removal of catheter on physician’s order • Long-term anticoagulation (3-6 months) • Thrombolytic therapy
