CVAD Care Flashcards
patient positioning for insertion of CVAD?
comfortable position with head slightly elevated; arm extended for PICC or midline device
how often do you change the dressing for a CVAD?
TSM dressing = every 5-7 days
Gauze dressing = every 2 days
Gauze under TSM = every 2 days
what indicates thrombosis?
arm measurement with a 3cm increase
when is CHG-impregnated dressings used and why?
for short term CVADs; reduce risk of infection
patient positioning for removal of CVAD?
supine or 10 degree Trendelenburg’s position unless contraindicated
if an infusion is running through the CVAD and the CVAD is to be dc’ed, what do you do?
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
how does the nurse remove a CVAD dressing?
gently pull straight out and parallel to skin
should the pt be instructed to do anything when you remove a CVAD and why?
yes; instruct pt to take deep breath and perform Vasalva maneuver as catheter is withdrawn, or exhale if cannot do Valsalva maneuver
when do you change the dressing that you put on post removal?
every 24 hours until healed
what is important to do after removal of a non tunneled CVAD?
inspect catheter integrity and position pt in a supine position for 30 mins
should catheter cultures be obtained routinely with CVAD removal?
no; only if CRBSI is suspected
what is the point of obtaining a chest xray?
gold standard to confirm tip placement and presence of pneumothorax
what are complx that can occur after insertion?
pneumothorax, cardiac arrhythmias, and nerve injury
what would you evaluate for post insertion complx?
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
when is subcutaneous infusion used?
used for selected meds like opioids, insulin and is also effective with meds to stop preterm labour and to treat pulm HTN
what factor determines infusion rate for CSQI?
rate of med absorption; most pts can absorb 1-2mL/hr of med but is more dependent on osmotic pressure
advantages of CSQI
- 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
CSQI and DM
pts with DM using insulin pumps generally require less insulin bc it is absorbed and used more efficiently
what gauge needle is used for CSQI?
25-27 gauge winged butterfly IV needle
when do you rotate sites for med admin for CSQI?
every 2-7 days or when complx occur
pain management benefits of CSQI
- 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
patient positioning when administering via CSQI route?
supine or sitting
most common sites for CSQI?
subclavicular or abdomen
how often do you change CSQI sites in children?
every 48-72 hrs or at first signs of inflmtn
hypodermoclysis therapy
CSQI delivery of isotonic IV solutions to dehydrated older adults
what is the mechanism of hyaluronidase?
facilitate dispersion and absorption of 1000mL or more of hydration solutions
rate of infusion for hypodermoclysis therapy?
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.
intraosseous infusion
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
onset of intraosseous infusion and types of fluids that can be infused via this route?
fluid reaches bloodstream fast bc bone marrow communicates directly with circulatory system; all fluids can be admin this route
is intraosseous used short term or long term?
short term temporary measure; only used until usual route of admin can be obtained bc of danger of osteomyelitis
if intraosseous is continued for an extended time, how often do you rotate sites and why?
every 2-3 days to lower risk for infection
is intraosseous infusion painful?
yes as it enters bone marrow cavity
how do you know the needle tip has reached bone marrow?
aspirate for bone marrow
how often is dressing and tubing changed for intraosseous infusions?
dressing = q24h tubing = q48h
assessments to complete while infusion is running and how often are they done?
- 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
what happens if needle becomes dislodged during an intraosseous infusion?
symptoms of circulatory impairment or pain and taut skin over site occur
what do you do if a bone chip or thick marrow occludes intraosseous needle?
stylet is passed through needle to clear it
what volume of air is necessary to be fatal in adults?
200-300mL; can enter in matter of seconds through central line
what does the consequences of an air embolism depend on?
the amount of air entering the bloodstream, the rate at which it enters, and its route into the bloodstream (venous or arterial)
what happens when air is introduced more rapidly or in larger volumes?
pulmonary artery pressure rise, putting strain on the right side of the heart
what body systems are affected by air embolisms?
cardio, pulm, neuro
do you remove a central line while the pt is seated upright?
NO!
what is the max amount of fluid you can infuse through a subcut infuser?
1-2mL
what is a major complx of intraosseous infusion?
fat emboli
what position should the client be in when removing a PICC line?
semi-fowlers with arm below heart level and head turned away from site
what dressing should be used after removal of CVAD?
sterile transparent occlusive dressing over gauze impregnated with petroleum jelly
what are nursing interventions to keep in mind when administering antibiotics via a CVAD?
abx can be sticky; therefore it is important to flush vigorously and flush using 20mL after admin
