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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
Q

Disadvantages of tunneled catheters

A

Not comfortable for patient and harder to place
Requires self care for dressing changes and flushes
Risk for infection

26
Q

Implanted Port

A

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
Q

Up to how many punctures can an implanted port take?

A

2,000

28
Q

A special right angle needle “Huber” is used for what?

A

Access and covered with a transparent dressing for infusions

29
Q

Advantages of Implanted Port

A 
Can remain for years
Requires no daily maintenance 
Maintains body image and mobility 
Low infection rate
Safe for all fluids and blood drawing
30
Q

Disadvantages of Implanted Port

A

More difficult and expensive insertion
Patient discomfort
Difficult removal
Minor discomfort with needle access

31
Q

How do RNs check to see for placement for Implanted Ports?

A

Aspirate

32
Q

What should you ask from a patient with an implanted port?

A

Port card

33
Q

PICC Lines

A

Inserted by a physician, ARNP, or specially trained RN

Access through brachial, cephalic, or basilic vein

34
Q

What are the two types of PICC lines?

A

Regular and Power (valved)

35
Q

Disadvantages of PICC lines?

A 
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
Q

Power PICCs: What is a PASV?

A

Pressure Activated Safety Valve

Built in valve in hub of PICC

37
Q

CVADs: Nursing Care

A

Wash hands and use gloves
Visually inspect and palpate
Always change dressing if damp, loose, or soiled
Sterile technique for dressing changes

38
Q

How long is a CVAD dressing good for if not otherwise soiled?

A

One week

39
Q

How long should you scrub the hub of a CVAD?

And with what?

A

15-30 seconds

Alcohol

40
Q

What should you check for prior to use?

How?

A

Blood

Aspirate

41
Q

What type of syringe should be used for a PICC line?

Why?

A

10-12mL

To prevent rupture

42
Q

What type of technique should be used when flushing?

A

Push-pause technique

43
Q

What should you make sure of maintaining with a non-valved line?

A

Positive pressure while clamping

44
Q

How often should IV sites and venous pathways be assessed?

A

q2 for continuous infusion
q12 for hep/saline lock not in use
With every dressing change

45
Q

What should be in the documentation of the insertion of a CVAD?

A

Date, brand, gauge, catheter length
Location (confirmation of X-Ray)
Length of segment
Client teaching

46
Q

What are some limitations to placement of CVAD?

A 
Lymph node dissection 
Presence of AV grafts and hemodialysis fistulas 
Skin integrity 
Anticoagulation therapy 
Patient condition unstable
47
Q

What are some insertion complications?

A 
Catheter malposition 
Arterial puncture
Catheter embolism 
Air embolism 
Pneumothorax
48
Q

S/S of air embolism

A

Chest pain
Cyanosis
Increased BP and pulse rate

49
Q

Prevention of air embolism includes:

A

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
Q

Displacement into the right atrium can cause what?

A

Tachycardia

Arrhythmias

51
Q

Infusing fluid into the pericardial sac can cause what?

A

Cardiac tamponade

52
Q

What are some Post insertion complications?

A

Catheter occlusion: blood clot
Catheter damage: rupture
Catheter related blood infections

Med/Surg 1 Exam 1 (5 decks)

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