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IM 2 > CVAD -exam 1 > Flashcards

CVAD -exam 1 Flashcards

1
Q

What is a CVAD?

A

Intravenous catheter or infusion port

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2
Q

What is a CVAD designed for?

A

To administer medications, nutrients, IV fluids and blood products through a central vein

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3
Q

How is the CVAD designed?

A

-One catheter
- multiple lumens, gauges, and exits

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4
Q

Distal CVAD

A

Blood draw, blood infusions, meds, CVP

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5
Q

Proximal - CVAD

A

IV fluids, meds, blood draw

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6
Q

Medial CVAD

A

TPN

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7
Q

The CVAD is inserted into — — in central circulation with catheter tip entering in _____

A
  1. Large veins
  2. Superior vena cava
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8
Q

How do you confirm CVAD placement

A

X-ray

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9
Q

How long are CVAD usually in? **

A

Moderate to long term use

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10
Q

Hemodialysis

A

Treatment to filter wastes and water from your blood

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11
Q

What are some indications for CVAD placement ?

A
  • hemodialysis
  • TPN
  • chemotherapy
  • multiple blood transfusions/ blood draws
  • long term antibiotics/ IV medications or solutions
  • central venous pressure monitoring
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12
Q

What should you tell the pt when preparing them for a CVAD?

A
  • the purpose
  • estimated length of time it will be in
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13
Q

What should you teach the pt about CVAD?

A

What to avoid and why

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14
Q

What should patients report about CVAD

A

Pain, tenderness, s/s infection

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15
Q

Post removal and care of CVAD

A

How we remove it and describe the process

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16
Q

What position should patient be in will insertion and removal of CVAD

A

Trendelenburg position

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17
Q

What are three kinds of CVAD?

A

Non tunneled
Tunneled
Port-a-cath

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18
Q

Where is the non tunneled CVAD placed?

A

Inserted directly into subclavian, jugular, femoral or peripheral vein

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19
Q

Which CVAD is secured by sutures outside the insertion site to the skin?

A

Non tunneled

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20
Q

How long are non tunneled usually left in?

A

Acute, moderate term ~ 6 weeks

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21
Q

Which CVAD has a higher infection rate?

A

Non-tunneled

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22
Q

Nurse can discontinue this CVAD

A

Non-tunneled

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23
Q

Where are PICC lines placed?

A
  • peripheral vein
  • basilic or cephalic vein IF peripheral vein can be accessed
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24
Q

Who places the PICC line?

A

PICC team or IR insertion

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25
Q

What 2 things would we NOT do to a arm with a PICC line ?

A

No phlebotomy or blood pressure

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26
Q

This line tends to clot easier

A

PICC line

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27
Q

Why does the PICC line clot easier? **

A

Down further, does not get flushed well

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28
Q

What are the three main tunneled CVAD?

A

Broviac
Groshong
Hickman

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29
Q

How is the tunneled CVAD placed?

A

Surgically tunneled beneath the skin

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30
Q

Why is the tunneled CVAD unique?

A

Dacron cuff

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31
Q

How is the Dacron cuff placed

A

Sutured in place (SQ) initially then scar tissue secures itself around the cuff

32
Q

What common sites do we use for the tunneled CVAD?

A

Subclavian vein and IJ and sometimes femoral vein

33
Q

How long is the tunneled CVAD in?

A

Chronic, long term, >6 weeks

34
Q

Can the nurse discontinue the tunneled CVAD?

A

No, it must be surgically removed

35
Q

How is the port-a-cath placed

A

Surgically implanted line below the skin tunneled

36
Q

Where is the port-a-cath placed?

A

External, tunneled through
- jugular
- subclavian
- cephalic/ basilic vein

37
Q

How long is the port-a-cath in?

A

Long term- months to years

38
Q

What kind of needle do we use to access port-a-cath

A

Huber needle

39
Q

Which port is less restrictive?

A

port-a-cath

40
Q

What is the port-a-cath made out of?

A

Silicone septum, sour rounded by titanium, stainless steel or plastic

41
Q

When does a nurse assess a CVAD?

A

Dressing changes
Med admin
IV fluids
As needed

Good practice to look everytime you are in the room

42
Q

How do we evaluate the CVAD

A

Palpate the area with gloves!
Ask for any pain or discomfort
Look for s/s of infection
Date of insertion

43
Q

When does the nurse need to notify the PCP/PICC team

A

Infection, no sutures, displacement

44
Q

What is a specific infection patients can get with CVAD ~ this is a complication

A

CLABSI

45
Q

What are signs and symptoms of CLABSI

A
  • redness
  • drainage
  • swelling
  • discomfort
    ~ at insertion site
46
Q

What are some nursing interventions to prevent CLABSI

A

Aseptic technique
Hand hygiene and gloves
Clean injection ports before EVERY access
Dressing changes as indicated
Patient and family teaching

47
Q

What do we clean port sites with?

A

Alcohol swabs

48
Q

Pneumothorax

A

Air in the pleural space outside the lung

49
Q

Signs and symptoms of pneumothorax

A

Dyspnea
Hypoxia
Tachycardia
Restlessness
Cyanosis
Chest pain
Decreased breath sounds

50
Q

What are nursing interventions for a patient with a pneumothorax

A

Vital signs
Administered oxygen
Notify PCP, CN, RRT
Prepare for a chest tube if indicated

51
Q

A collapsed lung is a

A

Pneumothorax

52
Q

Air embolism

A

Air entering the circulatory system

53
Q

Signs and symptoms of a air embolism

A
  • Dyspnea
  • chest pain
  • tachycardia
  • hypotension
  • anxiety
  • nausea
54
Q

What are some nursing interventions for a patient with an air embolism

A
  • keep linens clamped
  • administer o2
  • vital signs
  • place patient on left lateral side in trendelenburg position
  • stay with patient and notify Dr, CN, RRT
55
Q

Occlusion

A

Lack of blood rerun or sluggish flow

56
Q

Thrombosis

A

Clot that blocks the catheters lumen

57
Q

Catheter rupture

A

May be caused by excessive force when flushing

58
Q

Catheter migration

A

Displacement or lengthening of catheters

59
Q

Nursing interventions for a catheter that will not flush or have blood return

A
  • take deep breaths, cough
  • raise arms over head
  • have pt sit up or stand
  • change positions in bed
  • place in trendelenburg
  • administer ateplase
60
Q

Alteplase

A

Used to dissolve blood clots that have formed in blood vessels
- expensive

61
Q

Scrub the hub

A

Cleaning each lumen in between each use. Always clean!!

62
Q

How long do we “scrub the hub”

A

15 seconds

63
Q

What must the nurse always do to CVAD infusions to a pump?

A

Program

64
Q

How much of one flush do we use for a port/lumen

A

ONLY 10 ml

65
Q

When do we flush port/Lumens?

A
  • every shift
  • after every medication
  • after every blood draw
66
Q

When to do a dressing change?

A

24hours post insertion and then every 7 days, or PRN

67
Q

Max zero caps every —- with dressing change and PRN

A

7 days

68
Q

During a CVAD dressing change where should the overhead table be?**

A

In sight ALWAYS

69
Q

When putting masks on who should be the mask on first?

A

The nurse and then the patient

70
Q

Why do we turn the patients face away ?

A

Keep the air as clean as possible around the site while we clean it

71
Q

When we clean the CVAD site which direction are we going in?

A

Back and forth ONLY

72
Q

What is one thing the nurse should never do when cleaning around the insertion site?

A

Go back to the insertion site- could bring dirty to clean and we want clean to clean

73
Q

What kind of gauze does the patient cover the occlusive dressing with?

A

4x4 folded gauze

74
Q

When we cover with occlusive dressing how long do we leave this on?****

A

48 hours

75
Q

What should we measure with the PICC line?

A

Measure catheter length of PICC line

76
Q

How long should the patient remain supine ?

A

30 mins

IM 2 (17 decks)

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