CVAD part 2

Question 1

distal lumen used for

Answer 1

CVP monitoring, high volumes or viscous fluids

• colloids, meds
• used for BLOOD DRAWS
• 16 gauge

Question 2

medial lumen used for

Answer 2

• TPN
• meds
• 18 gauge

Question 3

proximal used for

Answer 3

• meds
• blood component administration
• 18 gauge

Question 4

tip of CVAD is where

Answer 4

threaded into the internal of external jugular veins or lower 1/3 of vena cava (superior or inferior) just above RA

Question 5

indications for CVADs

Answer 5

• admin long term IV fluid therapy
• antibiotics + other irritating meds
• chemo
• TPN
• Blood products
• central venous pressure monitoring
• obtain blood sample

Question 6

advantages of CVADs

Answer 6

• less vessel irritation
• less inflammation (less sclerosis, allows pt to receive IV therapy in the home)
• pts with poor venous access
• can be used for long periods of time

Question 7

verification of placement

Answer 7

-radio-opaque-shows up on x-rays

Question 8

securement device for CVAD

Answer 8

• anchoring device (stat lock)

- bio-patch

Question 9

flush push/pause method does?

Answer 9

• creates turbulence that helps clear the blood from the line
• increases turbidity in cath without increase in pressure

Question 10

how to create positive pressure with push/pause

Answer 10

1. at end of flush
2. prevents backflow of blood into catheter
3. Keep pressure on the plunger of the syringe while removing syringe from injection cap

Question 11

SASH

Answer 11

1. Saline
2. Admin medication
3. Saline
4. Heparin

Question 12

if resistance is met while pushing

Answer 12

• Discontinue

- NEVER FORCE FLUSH ON ANY LINE

Question 13

Infection SS

Answer 13

• high temp
• redness at site
• pain and tenderness
• purulent drainage
• induration

Question 14

Occlusion

Answer 14

• DONT FORCE!
• kinked or clamped?
• have pt turn head and cough
• raise arms over head
• place on left side Trendelenburg
• deep breath
• stand up
• change position in bed

Question 15

thrombosis

Answer 15

• turbulent flush
• admin thrombolytic
• tape port with “Do not use”

Question 16

air emboli

Answer 16

• caused by cracked catheter or unclamped line that opens

- have pt perform Valsalva when inserting line or clamp change

Question 17

if air emboli suspected

Answer 17

1. clamp the line
2. admin oxygen
3. Place pt on left side Trendelenburg
4. Stay with pt, call doc

Question 18

Removal of Catheter

Answer 18

1. Normal check-off
2. Have pt lie flat
3. Masks
4. For PICC, have tourniqute
5. prep sterile gauze with antibiotic ointment
6. remove dressing + securement device
7. HH- sterile gloves
8. remove sutures
9. Have pt turn head away and take deep breath or Valsalv
10. Remove line in slow steady motion while applying pressure to site with sterile gauze
11. Apply sterile gauze + dressing -hold pressure for 2-5 min-leave on 24 hrs
12. inspect cath for completeness
13. Pt should remain flat for 20 minutes after removal

Question 19

Nurses remove which 2 lines only

Answer 19

1. Non-tunneled

2. PICC

Question 20

how often is CVAD dressing changed

Answer 20

• q7days

- 24 hrs done after insertion

Question 21

importance of saline flush

Answer 21

• confirms patency
• avoid drug compatibility
• ensure entire dose of drug is delivered, and prevent thrombus formation

Question 22

metabolic complications of TPN

Answer 22

1. refeeding syndrome
2. hyper/hypo glycemia
3. altered renal function
4. essential fatty acid deficiency
5. liver dysfunction
6. hyperlipidemia

Question 23

catheter related complications to TPN

Answer 23

1. air embolus
2. pneumothorax, hemothorax, hydrothorax
3. Hemorrhage
4. Dislodgment
5. Thrombosis of vein
6. phlebitis
7. catheter-related sepsis
8. Occlusion

Question 24

refeeding syndrome

Answer 24

• fluid retention and electrolyte imbalance

- hypophosphatemia-LT

Question 25

Dressing change documentation

Answer 25

1. assessment of insertion site
2. type of catheter stabilization
3. Patient’s report of pain
4. external catheter length
5. status of insertion site
6. condition of previous dressing
7. site care performed
8. adherence to sterile technique
9. type of dressing applied
10. Site labeled with date, time, initials
11. patency of tube if checked

Question 26

Central line blood draw documentation

Answer 26

1. if appl, length of time infusion stopped prior to blood sampling
2. lab tests to be performed
3. amount of blood used for sampling
4. appropriate labeling of specimen collected
5. lumen used of blood sampling
6. patency of catheter + ability to flush and draw blood
7. Method used (syringe vs. evacuated collection tube system)
8. Follow-up care (cap replace, heparin flush, infusion restarted)