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Med surg 2 > CVAD > Flashcards

CVAD Flashcards

1
Q

CVAD stands for

A

Central Venous Access Device

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2
Q

With a CVAD you can administer what types of fluids/products

A

IV fluids, blood products and medications

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3
Q

The tip of the CVAD sits in the ________ or ________

A

Superior or Inferior Vena Cava

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4
Q

What 3 veins can the CVAD be inserted

A

internal jugular (IJ), subclavian vein, femoral vein or brachial vein. If femoral = more chance of infection

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5
Q

Another way CVAD can be placed

A

under the skin (aka port)

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6
Q

After placing CVAD - first thing you should verify_______ via_________

A

location of the tip via a chest xray (magnet)

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7
Q

One exception to verifying placement

A

if placed under fluoroscopy

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8
Q

What is Fluoroscopy?

A

imaging technique that uses X-rays to obtain real-time moving images of the interior of an object.

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9
Q

How long can CVADS remain in place (depending on the type)

A

several weeks to months

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10
Q

Who can benefit

A

those requiring long term IV treatments

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11
Q

What should you avoid giving in CVAD_______ or flushing with smaller syringe (< 10 ml) due to ____________

A

medications
may result in too much pressure = rupture of catheter

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12
Q

Some reasons to use CVAD

A

parenteral nutrition
chemo/other irritating (vesicant) solutions
Blood products
antibiotics
when peripheral access is limited
CVP (central Venous pressure) monitoring = fluid overload
Hemodialysis

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13
Q

What is the lumen of a catheter

A

hollow channel within a tube

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14
Q

Can you have more than one lumen?

A

Yes, single, multiple - up to 5

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15
Q

If you have single lumen and giving parenteral nutrition - what can’t you do?

A

use to sample or transfuse blood - as blood tends to stick to tubing - makes nutrition hard to flow

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16
Q

Names of ports of the lumen

A

proximal, medial distal

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17
Q

Type of catheters

A

Short
midline
PICC - Peripheral inserted central catheter
Non-tunneled percutaneous catheter (CVC)
Tunneled catheters
implanted ports
hemedialysis catheters

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18
Q

Short - how long?

A

3/4 - 1 1/4 inch

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19
Q

Short gauge?

A

26 (smallest) - 14 (largest)

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20
Q

Short timeframe in and when to assess

A

no specific (policy) and Q 4 hours minimum

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21
Q

Midline - how long

A

3-8 inches, 3-5 French and can be double or single

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22
Q

Midline - where placed

A

upper arm

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23
Q

midline used for

A

hydration and drug therapy

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24
Q

Midline time in

A

used when needed for up to 6 days and UP TO 14 DAYS!!!

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25
Q

Midline - do not use to

A

vesicant drugs, parenteral nutrition, draw blood

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26
Q

PICC means

A

Peripherally Inserted Central Catheter - LONG

27
Q

PICC is inserted

A

into basilic (preferred) or cephalic vein in arm

28
Q

PICC line ends

A

in the superior vena cava just above the right atrium - BAD IF IN ATRIUM - higher risk of thrombosis

29
Q

PICC - single or multiple lumens? Color is

A

yes, can be both
purple

30
Q

Gold standard placement verification for a PICC

A

3CG technology - magnetic tracking - CAN ONLY USE IF PT IS IN NORMAL SINUS RHYTHM

31
Q

Don’t use 3CG technology (magnet tracing) for PICC placement if

A

pt is not in NSR - normal sinus rhythm

32
Q

PICC indicated for

A

IV fluids, medications, blood and blood sampling - great for home IV treatments

33
Q

In arm with PICC - DO NOT

A

take BP, draw blood or any injections

34
Q

Greatest risk to pt with PICC

A

DVT and infection

35
Q

Non tunneled Central Venous Catheter - what makes it non tunneled?

A

It goes directly to vein and is not put under skin prior to the insertion point

36
Q

Where are Non tunneled Central Venous Catheters placed

A

subclavian in upper chest or jugular vein into Superior Vena Cava or less often femoral then Inferior Vena Cava

37
Q

Non tunneled duration_______ due to _____

A

short term due to high rate of infection (2 weeks) (access is direct to vein = bacteria)

38
Q

Tunneled central venous catheters - what makes them tunneled?

A

portion lies in a subq tunnel on skin

39
Q

What does tunneled have which helps reduce infection?

A

cuff with antibiotic at skin insertion

40
Q

when is tunneled used

A

frequent long term infusion

41
Q

why not just use a PICC instead of tunneled?

A

if someone uses there arms a lot - paraplegic

42
Q

What is a portacath?

A

device implanted under the skin - appears as a bump

43
Q

Implanted ports are most often used for_________ because of compromised immune system

A

chemo

44
Q

Is any of the catheter outside of body with portacath?

A

no - all under skin - port is self sealing

45
Q

How is portacath accessed?

A

Huber needle - a non coring/non barred needle - it is curved so it does not go through port

46
Q

How many times can you access portacath with same needle?

A

about 7 days

47
Q

Portacath - after accessing and prior to each use:

A

aspirate for blood return
flush with 10 ml NS

48
Q

Portacath - prior to deacessing, removing the needle

A

lock with heparin solution (per policy)
flush with NS

49
Q

Largest catheters

A

hemodialysis

50
Q

common complication for hemodialysis catheter

A

CLABSI = central line associated blood stream infection AND vein thrombosis

51
Q

Who can access

A

only trained Hemodialysis nurses

52
Q

Change hemodialysis dressing

A

Q 48 hours/with treatment/when soiled

53
Q

Most common infection with CVADS

A

staph aureus, yea and fungi

54
Q

what to monitor for infection

A

fever, redness, swelling, drainage, pain, chills

55
Q

How to prevent infections

A

proper technique - be sure draping and gloves are sterile,
wear gown and mask - everyone in room
hand hygiene
prepare insertion site with chlorhexidine and alcohol
Scrub the hub with alcohol at least 15 sec
dressing changes
access necessity daily (do they need it)
watch for early signs of infection

56
Q

Possible complication with CVADS

A

air embolus with discontinuation or when opened

57
Q

CVAD dressing changes mandate the use of

A

sterile technique

58
Q

Change CVAD dressings Q

A

7 days/hospital policy

59
Q

What to ask patient with catheters

A

allergies to chlorohexidine gluconate and latex

60
Q

New insertion of CVAD requires all new

A

tubing and fluids

61
Q

After completion and prior to shift

A

LABEL tubing, dressing and IVF and check them at start of shift!!

62
Q

What do to if no label?

A

change

63
Q

Cath often used with long term hemodyalisis patients

A

tunneled - fistula healing can take up to 6 mo

Med surg 2 (12 decks)

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