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Med/Surg 1 Exam 1 > CVAD > Flashcards

CVAD Flashcards

1
Q

What is a CVAD?

A

Vascular access device which is inserted into a central vein and terminates in the Superior or Inferior Vena Cava just above the right atrium

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2
Q

Who is Werner Forssman?

A

Advanced catheter into his heart
Won nobel peace prize
CVAD became widespreadly used

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3
Q

What is CVP?

A

Central venous pressure

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4
Q

Why are CVAD’s used?

A

Difficult peripheral access
Hypertonic solutions, vesicants, irritants
Inotropic infusions (dopamine, milnirone)
Meds, blood transfusions, TPN
Lab draws
CVP monitoring

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5
Q

What are the guidelines for CVAD need?

A

Long term use >6 days
TPN with D10% or higher (thick)
Vesicants (not good on the peripheral veins)
Meds or solutions with extreme pH or osmolarity

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6
Q

CVAD Planning: Assess for what?

A

Health problems
Patient preference
Purpose

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7
Q

CVAD Planning: The plan is to ?

A

Discuss with multidisciplinary team, patient/family

Ongoing assessment of site for complications: assess the need

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8
Q

Properties of a CVAD?

A

One or more lumen
Open or closed ended
May be used for short or long term therapy

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9
Q

Proximal

A

Opening closest to me (insertion site) or furthest from the heart

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10
Q

Medial

A

IF there may be one

Opening between proximal and distal

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11
Q

Distal

A

Opening furthest to me (insertion site) or closest to the heart
Biggest opening

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12
Q

From which lumen should blood be drawn?

A

Proximal (preferably)

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13
Q

What is the biggest concern with an open ended catheter?

And why?

A

Blood enters catheter when there is no infusion

Blood clotting and clogging catheter

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14
Q

What is a risk of open ended CVAD?

And what does it require?

A

Risk of air embolism or hemorrhage if disconnected
Requires clamping with exit from system
Requires periodic flushing

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15
Q

Closed Ended CVAD

A

Clamping not required
Valve is closed expect during infusion or aspiration
Heparin not needed for patency

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16
Q

What do you need when giving medication especially with an open-ended CVAD?
In order of use

A 
Syringe (empty) to aspirate
Flush
Medication 
Flush 
Heparin
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17
Q

What should be remembered when pushing a flush after medication in a CVAD?

A

To push at the same rate as medication for the same amount of mL of medication

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18
Q

SASH stands for?

A

Saline Flush
Administration of medication
Saline Flush
Heparin if indicated

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19
Q

What are the four basic types of CVAD?

A

Centrally Inserted Venous Catheter
Tunneled Catheter
Implanted Port
Peripherally Inserted Central Catheter

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20
Q

Centrally Inserted Venous Catheter

A

Placed percutaneously through the subclavian, femoral, or jugular vein and threaded into the Superior Vena Cava

Used for shorter term than PICC or Tunneled

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21
Q

What are some advantages of Centrally Inserted Venous Catheter?

A

Fastest way: inserted at bedside

Safe for all fluids and blood draws

22
Q

What are some disadvantages of Centrally Inserted Venous Catheter?

A

Highest risk for infection
Not for outpatient use (in hospital)
Short term use

23
Q

Tunneled catheters

A

Inserted in OR or interventional radiology
Exits the skin via a subcutaneous tunnel
Dacron cuff on the tunneled portion anchors catheter and acts as a barrier to infection

24
Q

Advantages of tunneled catheters

A

Good for intense, long term, and frequent therapy

Safe for all fluids and blood draws

25
Disadvantages of tunneled catheters
Not comfortable for patient and harder to place Requires self care for dressing changes and flushes Risk for infection
26
Implanted Port
Surgically implanted in a subcutaneous pocket Contains self sealing injection port with a catheter attached Catheter is threaded into the subclavian vein and SVC
27
Up to how many punctures can an implanted port take?
2,000
28
A special right angle needle "Huber" is used for what?
Access and covered with a transparent dressing for infusions
29
Advantages of Implanted Port
``` Can remain for years Requires no daily maintenance Maintains body image and mobility Low infection rate Safe for all fluids and blood drawing ```
30
Disadvantages of Implanted Port
More difficult and expensive insertion Patient discomfort Difficult removal Minor discomfort with needle access
31
How do RNs check to see for placement for Implanted Ports?
Aspirate
32
What should you ask from a patient with an implanted port?
Port card
33
PICC Lines
Inserted by a physician, ARNP, or specially trained RN | Access through brachial, cephalic, or basilic vein
34
What are the two types of PICC lines?
Regular and Power (valved)
35
Disadvantages of PICC lines?
``` May limit arm mobility Not ideal for rapid infusions May require self-care for dressing changes and flushes Some risk for infection Chance of rupture ```
36
Power PICCs: What is a PASV?
Pressure Activated Safety Valve | Built in valve in hub of PICC
37
CVADs: Nursing Care
Wash hands and use gloves Visually inspect and palpate Always change dressing if damp, loose, or soiled Sterile technique for dressing changes
38
How long is a CVAD dressing good for if not otherwise soiled?
One week
39
How long should you scrub the hub of a CVAD? | And with what?
15-30 seconds | Alcohol
40
What should you check for prior to use? | How?
Blood | Aspirate
41
What type of syringe should be used for a PICC line? | Why?
10-12mL | To prevent rupture
42
What type of technique should be used when flushing?
Push-pause technique
43
What should you make sure of maintaining with a non-valved line?
Positive pressure while clamping
44
How often should IV sites and venous pathways be assessed?
q2 for continuous infusion q12 for hep/saline lock not in use With every dressing change
45
What should be in the documentation of the insertion of a CVAD?
Date, brand, gauge, catheter length Location (confirmation of X-Ray) Length of segment Client teaching
46
What are some limitations to placement of CVAD?
``` Lymph node dissection Presence of AV grafts and hemodialysis fistulas Skin integrity Anticoagulation therapy Patient condition unstable ```
47
What are some insertion complications?
``` Catheter malposition Arterial puncture Catheter embolism Air embolism Pneumothorax ```
48
S/S of air embolism
Chest pain Cyanosis Increased BP and pulse rate
49
Prevention of air embolism includes:
Trendelenberg position during insertion Keep catheter capped when not in use Always expel air from syringe prior to administration Do not allow IVF to run dry
50
Displacement into the right atrium can cause what?
Tachycardia | Arrhythmias
51
Infusing fluid into the pericardial sac can cause what?
Cardiac tamponade
52
What are some Post insertion complications?
Catheter occlusion: blood clot Catheter damage: rupture Catheter related blood infections

Med/Surg 1 Exam 1 (5 decks)

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