CVAD Flashcards
CVC drsg change skill
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
what PPE do you need for CVC drsg change
gloves, mask, sterile gloves
what PPE might pt need
mask or tell them to turn away
when to put on sterile gloves for CVC drsg change
after opening your sterile kit
simplified version of CVC drsg change
- 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
simplified blood draw
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!)
what should you do if you want to draw blood but the pt has fluid infusing
stop it and wait 1 min
long version of blood draw
which lumen do you draw blood from
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
pos for pt to remove nontunneled catheters or PICCs
10 degree trendelenburg
PPE for removing CVC or PICC
gown mask gloves goggles
steps up to pulling out CVC
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,
what to instruct pt to do before you remove the CVC
take a deep breath and bear down
what kind of gloves do you wear to remove a drain
steril
steps once pulling out CVC
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?
what is an intraosseus infusion
• Intraosseus infusion is infusion of fluid into bone marrow cavity of long bone,
which bones are used for intraosseus infusion
, gen the distal or proximal tibia, distal femur, iliac crest
is intraosseus an effective way for fluids to reach the circ system
yes.
what can you give intraosseusly
all fluids even whole blood
why would an intraosseus infusion be used
• Intraosseus infusion is used in emergenc when diff to establish gen IV access or when burns cover the usual access sites for periph IV
clean or sterile technique for intraosseus?
sterile
how long should intraosseus be left in before insertion site should be changed
what is the risk if left in?
• Temporary meas d/t risk of osteomyelitis. If continued the insertion point should be rotated q2-3 days
how often is intraosseus tubing changed?
drsg?
tubing q48 and drsg q24
what should be assesed if initiating infusion in leg
distal pulse, temp, color of leg all to check circ
what is a danger regarding securement during intraosseus start
the leg must be restrained
what kind of meds or for what fx are continuous subcut meds given
• CSCI route is for specific meds like insulin of opioids
can be used to stop preterm labor
can be used to Tx pulmonary HTN
where can CSCut injections be given
reg subcut spots and upper chest
where is insulin absorbed most consistently
• Insulin is absorbed more consistently in abdm
for an ambulatory pt where is it best for their CSC to be if for pain meds
on upper chest
not sure why? out of the way?
what are the benefits of CSC vs other routes of meds for pain
• 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
what size needle are you using for CSC
25-27 gauge
procedure for starting CSC and inserting it
- 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
how to rmove CSC
- 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
how ften do you assess a CSCI site
q4h
what to chart after starting CSCI
chart med, dose, route, time, date, type of med pump
how often should you switch the CSCI site in a kid
• Clean and change CSCI sites in kids q48 or 72 or at first signs of inflm
after removing a CVC how long should you apply pressure for
and if theyre being anticoagulated
5min
10min
when doing a blood draw do you leave the cap on
no. but zero max caps can be left on
how long do you have during blood draw before blood coagulates
2min
if you want to do a blood draw but the line had a med runnin through it what do?
turn off or clamp line wait a minute
flush w 20ml? or maybe flush first and wait a minute?
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
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
