CVAD

Question 1

reasons for cvad prescriptions

Answer 1

• vital for critically ill
• medications
• prolonged antibiotics admin
• iv fluids
• blood samples

Question 2

where cvads are placed

Answer 2

in the svc or ra

Question 3

types of cvads

Answer 3

• non tunnled
• tunneled (hickman)
• implanted infusion port (port-a-cath)
• picc line

Question 4

non tunneled cvads

Answer 4

• inserted directly into central vein
• 1 to 5 lumens
• highest risk of infection (short term use)
• fast access
• used for: blood abx, tpn, long term chemo

Question 5

tunneled cvads

Answer 5

• placed during surgery, inserted into the chest, and tunneled through percutaneous tissue (less chance for infection)
• verify placement via x ray
• can have 1 or more lumen
• synthetic cuff to anchor the catheter for stability
• long term use
• no dressing after healing

Question 6

implanted port (port-a-cath)

Answer 6

• chest wall pocket, surgically inserted into subclavian vein, tip in the svc
• long term use, over 1 year
• assess with a non coring (huber) needle
• gives freedom, little care
• commonly used for chemo

Question 7

picc lines

Answer 7

• inserted in basiclic, cephalic, brachial, or medial cubital vein of the arm
• 1 week to 6 months
• can be placed surgically or non surgically at bedside
• risk for infection
• monitor for crbsi

Question 8

contraindications for picc lines

Answer 8

• skin infection
• burns
• end stage renal failure
• crutches
• increased vasostimulation can cause movement of the veins and dislodge the catheter

Question 9

how to flush cvad ports

Answer 9

• aspirate blood return to check for placement
• flush with pulsating technique
• flush before and after meds, and every shift

Question 10

how to get blood sample via svad

Answer 10

• stop infusion for atleast 1 minute
• flush 10ml ns (if tpn infusing, flush with 20ml)
• use empty 10ml syringe to with draw 10ml blood, discard
• connect new syringe and withdraw amount of blood needed
• flush with 10ml ns, pulsating technique
• close safety clamp to maintain positive presure

Question 11

admin meds via cvad

Answer 11

• flush with 10ml saline
• open clamp
• aspirate blood return
• flush with saline
• attatch meds and admin at appropriate rate
• flush with saline
• maintain positive pressure
• close clamp

Question 12

cvad dressing change

Answer 12

• usually q 7 days
• assess for redness, swelling, drainage, tenderness, condition of dressing
• nurse and pt wear mask, nurse wear bonnet
• aseptic technique
• measure catheter length
• use chloraprep (blue sky to insertion site)

Question 13

discontinuing non tunnled cvad

Answer 13

• may require credentials
• position in supine lying down it insertion below level of heart, never sitting
• wash hands and don gloves
• remove old dressing and sutures
• gently pull catheter out while pt bears down (prevent entry of air)
• apply occlusive dressing immediately
• insepect catheter tip: intact, measure, compare length to insertion
• document

Question 14

potential cvad complications

Answer 14

• pneumothorax

- air embolism

Question 15

s/s of pneumothorax

Answer 15

• sob
• cough
• cp
• hypotension
• tachycardia
• anxiety

Question 16

s/s of air embolism

Answer 16

• dyspnea
• cp radiating to shoulder
• pale skin
• nausea
• hypotension
• light headed
• tachycardia
• decrease CO
• shock
• death

Question 17

response to air embolism

Answer 17

• clamp catheter and lumen clamps
• place on left side, head down
• check vitals
• apply o2 with o2 sat monitoring
• auscultate lungs
• call md, rt
• reassure pt
• iv access

Question 18

education for home care

Answer 18

• handwashing
• scrub hub
• frequent dressing changes
• keep pic dry
• avoid sharp pointy objects about picc
• watch if catheter length changes
• avoid lowering chest below waist
• avoid lifting anything heavier than 10 lbs
• drink plenty of water

Question 19

when to call hcp

Answer 19

• pain at catheter site
• fever
• chills
• vomiting
• coughing, wheezing, sob
• racing or irregular heartbeat
• s/s of infection