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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
What 2 things would we NOT do to a arm with a PICC line ?
No phlebotomy or blood pressure
26
This line tends to clot easier
PICC line
27
Why does the PICC line clot easier? ****
Down further, does not get flushed well
28
What are the three main tunneled CVAD?
Broviac Groshong Hickman
29
How is the tunneled CVAD placed?
Surgically tunneled beneath the skin
30
Why is the tunneled CVAD unique?
Dacron cuff
31
How is the Dacron cuff placed
Sutured in place (SQ) initially then scar tissue secures itself around the cuff
32
What common sites do we use for the tunneled CVAD?
Subclavian vein and IJ and sometimes femoral vein
33
How long is the tunneled CVAD in?
Chronic, long term, >6 weeks
34
Can the nurse discontinue the tunneled CVAD?
No, it must be surgically removed
35
How is the port-a-cath placed
Surgically implanted line below the skin tunneled
36
Where is the port-a-cath placed?
External, tunneled through - jugular - subclavian - cephalic/ basilic vein
37
How long is the port-a-cath in?
Long term- months to years
38
What kind of needle do we use to access port-a-cath
Huber needle
39
Which port is less restrictive?
port-a-cath
40
What is the port-a-cath made out of?
Silicone septum, sour rounded by titanium, stainless steel or plastic
41
When does a nurse assess a CVAD?
Dressing changes Med admin IV fluids As needed Good practice to look everytime you are in the room
42
How do we evaluate the CVAD
Palpate the area with gloves! Ask for any pain or discomfort Look for s/s of infection Date of insertion
43
When does the nurse need to notify the PCP/PICC team
Infection, no sutures, displacement
44
What is a specific infection patients can get with CVAD ~ this is a complication
CLABSI
45
What are signs and symptoms of CLABSI
- redness - drainage - swelling - discomfort ~ at insertion site
46
What are some nursing interventions to prevent CLABSI
Aseptic technique Hand hygiene and gloves Clean injection ports before EVERY access Dressing changes as indicated Patient and family teaching
47
What do we clean port sites with?
Alcohol swabs
48
Pneumothorax
Air in the pleural space outside the lung
49
Signs and symptoms of pneumothorax
Dyspnea Hypoxia Tachycardia Restlessness Cyanosis Chest pain Decreased breath sounds
50
What are nursing interventions for a patient with a pneumothorax
Vital signs Administered oxygen Notify PCP, CN, RRT Prepare for a chest tube if indicated
51
A collapsed lung is a
Pneumothorax
52
Air embolism
Air entering the circulatory system
53
Signs and symptoms of a air embolism
- Dyspnea - chest pain - tachycardia - hypotension - anxiety - nausea
54
What are some nursing interventions for a patient with an air embolism
- 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
Occlusion
Lack of blood rerun or sluggish flow
56
Thrombosis
Clot that blocks the catheters lumen
57
Catheter rupture
May be caused by excessive force when flushing
58
Catheter migration
Displacement or lengthening of catheters
59
Nursing interventions for a catheter that will not flush or have blood return
- take deep breaths, cough - raise arms over head - have pt sit up or stand - change positions in bed - place in trendelenburg - administer ateplase
60
Alteplase
Used to dissolve blood clots that have formed in blood vessels - expensive
61
Scrub the hub
Cleaning each lumen in between each use. Always clean!!
62
How long do we “scrub the hub”
15 seconds
63
What must the nurse always do to CVAD infusions to a pump?
Program
64
How much of one flush do we use for a port/lumen
ONLY 10 ml
65
When do we flush port/Lumens?
- every shift - after every medication - after every blood draw
66
When to do a dressing change?
24hours post insertion and then every 7 days, or PRN
67
Max zero caps every —- with dressing change and PRN
7 days
68
During a CVAD dressing change where should the overhead table be?****
In sight ALWAYS
69
When putting masks on who should be the mask on first?
The nurse and then the patient
70
Why do we turn the patients face away ?
Keep the air as clean as possible around the site while we clean it
71
When we clean the CVAD site which direction are we going in?
Back and forth ONLY
72
What is one thing the nurse should never do when cleaning around the insertion site?
Go back to the insertion site- could bring dirty to clean and we want clean to clean
73
What kind of gauze does the patient cover the occlusive dressing with?
4x4 folded gauze
74
When we cover with occlusive dressing how long do we leave this on?******
48 hours
75
What should we measure with the PICC line?
Measure catheter length of PICC line
76
How long should the patient remain supine ?
30 mins

IM 2 (17 decks)

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