CVAD Care

Question 1

patient positioning for insertion of CVAD?

Answer 1

comfortable position with head slightly elevated; arm extended for PICC or midline device

Question 2

how often do you change the dressing for a CVAD?

Answer 2

TSM dressing = every 5-7 days

Gauze dressing = every 2 days

Gauze under TSM = every 2 days

Question 3

what indicates thrombosis?

Answer 3

arm measurement with a 3cm increase

Question 4

when is CHG-impregnated dressings used and why?

Answer 4

for short term CVADs; reduce risk of infection

Question 5

patient positioning for removal of CVAD?

Answer 5

supine or 10 degree Trendelenburg’s position unless contraindicated

Question 6

if an infusion is running through the CVAD and the CVAD is to be dc’ed, what do you do?

Answer 6

If IV solutions or meds are to continue, arrange placement of a short-peripheral or midline before CVAD discontinuation; turn off infusion and convert to alternate VAD

Question 7

how does the nurse remove a CVAD dressing?

Answer 7

gently pull straight out and parallel to skin

Question 8

should the pt be instructed to do anything when you remove a CVAD and why?

Answer 8

yes; instruct pt to take deep breath and perform Vasalva maneuver as catheter is withdrawn, or exhale if cannot do Valsalva maneuver

Question 9

when do you change the dressing that you put on post removal?

Answer 9

every 24 hours until healed

Question 10

what is important to do after removal of a non tunneled CVAD?

Answer 10

inspect catheter integrity and position pt in a supine position for 30 mins

Question 11

should catheter cultures be obtained routinely with CVAD removal?

Answer 11

no; only if CRBSI is suspected

Question 12

what is the point of obtaining a chest xray?

Answer 12

gold standard to confirm tip placement and presence of pneumothorax

Question 13

what are complx that can occur after insertion?

Answer 13

pneumothorax, cardiac arrhythmias, and nerve injury

Question 14

what would you evaluate for post insertion complx?

Answer 14

a. Auscultate breath sounds and evaluate SOB, chest pain, absent breath sounds
b. Monitor VS, including HR and rhythm
c. Monitor pt complaints of pain, numbness, tingling, or weakness

Question 15

when is subcutaneous infusion used?

Answer 15

used for selected meds like opioids, insulin and is also effective with meds to stop preterm labour and to treat pulm HTN

Question 16

what factor determines infusion rate for CSQI?

Answer 16

rate of med absorption; most pts can absorb 1-2mL/hr of med but is more dependent on osmotic pressure

Question 17

advantages of CSQI

Answer 17

• pts are able to manage their illness and/or pain without the risks and expenses involved with IV med admin
• elatively easily for families and pts to learn and understand
• improves oncological and postoperative pain control in infants, children, and adults

Question 18

CSQI and DM

Answer 18

pts with DM using insulin pumps generally require less insulin bc it is absorbed and used more efficiently

Question 19

what gauge needle is used for CSQI?

Answer 19

25-27 gauge winged butterfly IV needle

Question 20

when do you rotate sites for med admin for CSQI?

Answer 20

every 2-7 days or when complx occur

Question 21

pain management benefits of CSQI

Answer 21

• Benefits pts with poor venous access
  
  • Provides pain relief to pts who are unable to tolerate oral pain meds
  • Allows pts greater mobility
  • Onset of action about 20 mins
  • Better pain control than IM injections
  • Lower rates of infection

Question 22

patient positioning when administering via CSQI route?

Answer 22

supine or sitting

Question 23

most common sites for CSQI?

Answer 23

subclavicular or abdomen

Question 24

how often do you change CSQI sites in children?

Answer 24

every 48-72 hrs or at first signs of inflmtn

Question 25

hypodermoclysis therapy

Answer 25

CSQI delivery of isotonic IV solutions to dehydrated older adults

Question 26

what is the mechanism of hyaluronidase?

Answer 26

facilitate dispersion and absorption of 1000mL or more of hydration solutions

Question 27

rate of infusion for hypodermoclysis therapy?

Answer 27

Infuse fluids slowly (eg. 30 ml/hr) during the first hour of therapy. If the pt remains comfortable, you can increase the rate of infusion. Usually infusion rates do not exceed 60 ml/hr.

Question 28

intraosseous infusion

Answer 28

infusion of fluid into the bone marrow cavity of the long bone, usually the distal or proximal tibia, the distal femur, or the iliac crest

Question 29

onset of intraosseous infusion and types of fluids that can be infused via this route?

Answer 29

fluid reaches bloodstream fast bc bone marrow communicates directly with circulatory system; all fluids can be admin this route

Question 30

is intraosseous used short term or long term?

Answer 30

short term temporary measure; only used until usual route of admin can be obtained bc of danger of osteomyelitis

Question 31

if intraosseous is continued for an extended time, how often do you rotate sites and why?

Answer 31

every 2-3 days to lower risk for infection

Question 32

is intraosseous infusion painful?

Answer 32

yes as it enters bone marrow cavity

Question 33

how do you know the needle tip has reached bone marrow?

Answer 33

aspirate for bone marrow

Question 34

how often is dressing and tubing changed for intraosseous infusions?

Answer 34

dressing = q24h
tubing = q48h

Question 35

assessments to complete while infusion is running and how often are they done?

Answer 35

• Assess for distal pulse and adequate temp and colour of leg every hour throughout infusion to ensure there is adequate circulation to extremities
• 02 sat monitor placed on toe distal to infusion

Question 36

what happens if needle becomes dislodged during an intraosseous infusion?

Answer 36

symptoms of circulatory impairment or pain and taut skin over site occur

Question 37

what do you do if a bone chip or thick marrow occludes intraosseous needle?

Answer 37

stylet is passed through needle to clear it

Question 38

what volume of air is necessary to be fatal in adults?

Answer 38

200-300mL; can enter in matter of seconds through central line

Question 39

what does the consequences of an air embolism depend on?

Answer 39

the amount of air entering the bloodstream, the rate at which it enters, and its route into the bloodstream (venous or arterial)

Question 40

what happens when air is introduced more rapidly or in larger volumes?

Answer 40

pulmonary artery pressure rise, putting strain on the right side of the heart

Question 41

what body systems are affected by air embolisms?

Answer 41

cardio, pulm, neuro

Question 42

do you remove a central line while the pt is seated upright?

Answer 42

NO!

Question 43

what is the max amount of fluid you can infuse through a subcut infuser?

Answer 43

1-2mL

Question 44

what is a major complx of intraosseous infusion?

Answer 44

fat emboli

Question 45

what position should the client be in when removing a PICC line?

Answer 45

semi-fowlers with arm below heart level and head turned away from site

Question 46

what dressing should be used after removal of CVAD?

Answer 46

sterile transparent occlusive dressing over gauze impregnated with petroleum jelly

Question 47

what are nursing interventions to keep in mind when administering antibiotics via a CVAD?

Answer 47

abx can be sticky; therefore it is important to flush vigorously and flush using 20mL after admin