CVAD

Question 1

CVC drsg change skill

Answer 1

o Position pt w head slightly elevated, or arm elevated if PICC or midline
o If transparent drsg do site care 5-7 days PRN if gauze q48
o Hand hygiene and mask then gloves. Remove old drsg in direction of catheter insertion. Discard in approp biohazard container
o Remove catheter stabilization device if used (with alcohol)
o Inspect site and skin, meas arm citcumerence for thrombosis
o Remove gloves, hygiene.
o Sterile technique to open kit and then Sterile gloves
o Cleanse site w chlorhexidine preferably w back and forth motion horizontally and then vertically min 30 seconds. An use povidone iodine too
o Skin protectant for entire area. Allo to dry completely
o Apply new catheter stabilization device
o Apply TSM or gauze over site
o Label w date time initial

Question 2

what PPE do you need for CVC drsg change

Answer 2

gloves, mask, sterile gloves

Question 3

what PPE might pt need

Answer 3

mask or tell them to turn away

Question 4

when to put on sterile gloves for CVC drsg change

Answer 4

after opening your sterile kit

Question 5

simplified version of CVC drsg change

Answer 5

• alcohol to remove drsg
• open sterile kit and prep
• w sterile gloves cleanse w chlorhexidine
• maybe skin protectant or just put on new stabilization device or drsg

Question 6

simplified blood draw

Answer 6

cleanse and flush w 5ml NS

• take off cap
• disinfect
• w 10ml syringe withdraw 5ml blood and discard
• cleanse, clamp whatever
• draw blood in syringe for spec
• flush w 10ml (in class she said 20ml I think its 20!)

Question 7

what should you do if you want to draw blood but the pt has fluid infusing

Answer 7

stop it and wait 1 min

Question 8

long version of blood draw

which lumen do you draw blood from

Answer 8

o With gloves turn off infusions for min 1 minute before drawing
o If multilumen use distal lumen
o Clean injection cap, allow to dry fully then attach syringe and flush w 3-5ml of Nacl
o Syringe method
o Remove end of tubing and keep terile
o Disinfet hub
o Attach 10ml syring and unclamp catheter withdraw blood 1.5-2times fill vol 4-5ml of catheter for the discard sample
o Reclamp catheter if nec and remove syringe w blood nd discard
o Clean hub
o Second syring for spec orered
o Unclamp cath if nec to withdraw blood
o Once pecs obtained reclamp cath and remove syringe
o Clean hub
o Attach 10ml Nacl syringe unclamp flush reclamp
o Transfer blood using transfer vacuum device?
o Flush catheter w heparin?
o Attach hub/tube back cleansing end of tubing first then resume infusion

Question 9

pos for pt to remove nontunneled catheters or PICCs

Answer 9

10 degree trendelenburg

Question 10

PPE for removing CVC or PICC

Answer 10

gown mask gloves goggles

Question 11

steps up to pulling out CVC

Answer 11

o If IV fluids or meds are to continue prep to convert them to periph or midline before dc
o Pos pt in 10 degree trendelenburg
o Hygiene, stop fluids, moisture proof pad under site
o Gown, mask, gloves, goggles
o Remove drsg and assess site
o Gloves removed, hygiene
o Open CVd removal kit and add additional items to field. Sterile gloves o
o Cean site w chlorhexidine or antiseptic swabs
o Remove securement devices
o Remove sutures w nondominant hand holding forceps and dominant cutting
o Apply sterile 4x4 to ite,

Question 12

what to instruct pt to do before you remove the CVC

Answer 12

take a deep breath and bear down

Question 13

what kind of gloves do you wear to remove a drain

Answer 13

steril

Question 14

steps once pulling out CVC

Answer 14

instruct pt to take deep breath and hold it as you withdraw catheter
o Remove catheter in smooth continuous motion 1 inch a time, keep fingers near insertion site and immed apply P to site and continue until bleeding stops
o Apply petroleum ointment to exit site and sterile occlusive rsg to site. Change drsg q24hrs. Label.
o Catheter integrity?
o Return pt to comfy pos
o Rate correct?

Question 15

what is an intraosseus infusion

Answer 15

• Intraosseus infusion is infusion of fluid into bone marrow cavity of long bone,

Question 16

which bones are used for intraosseus infusion

Answer 16

, gen the distal or proximal tibia, distal femur, iliac crest

Question 17

is intraosseus an effective way for fluids to reach the circ system

Answer 17

yes.

Question 18

what can you give intraosseusly

Answer 18

all fluids even whole blood

Question 19

why would an intraosseus infusion be used

Answer 19

• Intraosseus infusion is used in emergenc when diff to establish gen IV access or when burns cover the usual access sites for periph IV

Question 20

clean or sterile technique for intraosseus?

Answer 20

sterile

Question 21

how long should intraosseus be left in before insertion site should be changed
what is the risk if left in?

Answer 21

• Temporary meas d/t risk of osteomyelitis. If continued the insertion point should be rotated q2-3 days

Question 22

how often is intraosseus tubing changed?

drsg?

Answer 22

tubing q48 and drsg q24

Question 23

what should be assesed if initiating infusion in leg

Answer 23

distal pulse, temp, color of leg all to check circ

Question 24

what is a danger regarding securement during intraosseus start

Answer 24

the leg must be restrained

Question 25

what kind of meds or for what fx are continuous subcut meds given

Answer 25

• CSCI route is for specific meds like insulin of opioids
can be used to stop preterm labor
can be used to Tx pulmonary HTN

Question 26

where can CSCut injections be given

Answer 26

reg subcut spots and upper chest

Question 27

where is insulin absorbed most consistently

Answer 27

• Insulin is absorbed more consistently in abdm

Question 28

for an ambulatory pt where is it best for their CSC to be if for pain meds

Answer 28

on upper chest

not sure why? out of the way?

Question 29

what are the benefits of CSC vs other routes of meds for pain

Answer 29

•	Pain mgmt benefits: good for those w poor venous access; 
pain relief if cant tolerate PO meds; 
inc mobility;
 onset in 20mins;
better pain control than IM; 
costs ½ of those of IV infusions

Question 30

what size needle are you using for CSC

Answer 30

25-27 gauge

Question 31

procedure for starting CSC and inserting it

Answer 31

• Connect syringe and prime tubing
• Put syringe in pump
• Warn pt of brun or sting w insertion
• Pos pt supine. Most common sites are subclavicular and abdm
• Clean site, pinch, insert at 45-90 (shorter needles are sometimes inserted at 90)
• Release fold and apply tape over wings
• Place occlusive drsg over insertion site
• Attach tubing from needle to pump and turn on pump

Question 32

how to rmove CSC

Answer 32

• Stop pump, remove drsg and discard,
• remove tape from wings
• pull out needle at same angle inserted
• apply gentle P at site until no fluid leaks out of skin
• apply sm sterile gauze drsg or adhesive bandage to site

Question 33

how ften do you assess a CSCI site

Answer 33

q4h

Question 34

what to chart after starting CSCI

Answer 34

chart med, dose, route, time, date, type of med pump

Question 35

how often should you switch the CSCI site in a kid

Answer 35

• Clean and change CSCI sites in kids q48 or 72 or at first signs of inflm

Question 36

after removing a CVC how long should you apply pressure for

and if theyre being anticoagulated

Answer 36

5min

10min

Question 37

when doing a blood draw do you leave the cap on

Answer 37

no. but zero max caps can be left on

Question 38

how long do you have during blood draw before blood coagulates

Answer 38

2min

Question 39

if you want to do a blood draw but the line had a med runnin through it what do?

Answer 39

turn off or clamp line wait a minute

flush w 20ml? or maybe flush first and wait a minute?

Question 40

if you are trying to get a blood draw but no blood can be aspirated how do you assess if the line is still in place or having a malfunction

Answer 40

get pt to change pos, cough, deep breath, raise and lower arms
try flushing and if you cant then connect direct to hub (not through cap and try again)
if you were able to flush but you still cant get blood return then repeat the moving around stuff from first step
if you still cant get blood return then flush w 20ml
if this doesnt work youll need drs order