CVAD part 2 Flashcards
distal lumen used for
CVP monitoring, high volumes or viscous fluids
- colloids, meds
- used for BLOOD DRAWS
- 16 gauge
medial lumen used for
- TPN
- meds
- 18 gauge
proximal used for
- meds
- blood component administration
- 18 gauge
tip of CVAD is where
threaded into the internal of external jugular veins or lower 1/3 of vena cava (superior or inferior) just above RA
indications for CVADs
- admin long term IV fluid therapy
- antibiotics + other irritating meds
- chemo
- TPN
- Blood products
- central venous pressure monitoring
- obtain blood sample
advantages of CVADs
- 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
verification of placement
-radio-opaque-shows up on x-rays
securement device for CVAD
- anchoring device (stat lock)
- bio-patch
flush push/pause method does?
- creates turbulence that helps clear the blood from the line
- increases turbidity in cath without increase in pressure
how to create positive pressure with push/pause
- at end of flush
- prevents backflow of blood into catheter
- Keep pressure on the plunger of the syringe while removing syringe from injection cap
SASH
- Saline
- Admin medication
- Saline
- Heparin
if resistance is met while pushing
- Discontinue
- NEVER FORCE FLUSH ON ANY LINE
Infection SS
- high temp
- redness at site
- pain and tenderness
- purulent drainage
- induration
Occlusion
- 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
thrombosis
- turbulent flush
- admin thrombolytic
- tape port with “Do not use”
air emboli
- caused by cracked catheter or unclamped line that opens
- have pt perform Valsalva when inserting line or clamp change
if air emboli suspected
- clamp the line
- admin oxygen
- Place pt on left side Trendelenburg
- Stay with pt, call doc
Removal of Catheter
- Normal check-off
- Have pt lie flat
- Masks
- For PICC, have tourniqute
- prep sterile gauze with antibiotic ointment
- remove dressing + securement device
- HH- sterile gloves
- remove sutures
- Have pt turn head away and take deep breath or Valsalv
- Remove line in slow steady motion while applying pressure to site with sterile gauze
- Apply sterile gauze + dressing -hold pressure for 2-5 min-leave on 24 hrs
- inspect cath for completeness
- Pt should remain flat for 20 minutes after removal
Nurses remove which 2 lines only
- Non-tunneled
2. PICC
how often is CVAD dressing changed
- q7days
- 24 hrs done after insertion
importance of saline flush
- confirms patency
- avoid drug compatibility
- ensure entire dose of drug is delivered, and prevent thrombus formation
metabolic complications of TPN
- refeeding syndrome
- hyper/hypo glycemia
- altered renal function
- essential fatty acid deficiency
- liver dysfunction
- hyperlipidemia
catheter related complications to TPN
- air embolus
- pneumothorax, hemothorax, hydrothorax
- Hemorrhage
- Dislodgment
- Thrombosis of vein
- phlebitis
- catheter-related sepsis
- Occlusion
refeeding syndrome
- fluid retention and electrolyte imbalance
- hypophosphatemia-LT
Dressing change documentation
- assessment of insertion site
- type of catheter stabilization
- Patient’s report of pain
- external catheter length
- status of insertion site
- condition of previous dressing
- site care performed
- adherence to sterile technique
- type of dressing applied
- Site labeled with date, time, initials
- patency of tube if checked
Central line blood draw documentation
- if appl, length of time infusion stopped prior to blood sampling
- lab tests to be performed
- amount of blood used for sampling
- appropriate labeling of specimen collected
- lumen used of blood sampling
- patency of catheter + ability to flush and draw blood
- Method used (syringe vs. evacuated collection tube system)
- Follow-up care (cap replace, heparin flush, infusion restarted)
