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NRSG 301 > CVADs > Flashcards

CVADs Flashcards

1
Q

what would you do if you were unable to flush/ aspirate a line

A

suspect occlusion

Check for kinks in tubing

change dressing/ check site for:
- Kinks/ twists under dressing
- Tight sutures
- Obstructing securement device
- Remove end cap/ repeat patency assessment

if still not able to aspirate:
- Check for correct needle position/ replace non-caring needle
- Have pt take deep breath/ cough, change position, raise/ lower arm
- Flush with 1-2mL
- If able to aspirate flush with 20mL
- If not able to aspirate label do not use and notify IV nurse or MRP

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2
Q

while doing the PICC dressing you notice that the catheter is longer than it was documented to be what would you do?

A
  • Suspect catheter malposition
  • Stop infusion
  • Change dressing
  • do not reinsert catheter
  • Measure/ document new external length if greater than 2cm difference label do not use and notify IV nurse or MRP
  • Consider need for PVAD PRN
  • If length measured less than 2cm difference flush with 20mL
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3
Q

What do you do if you removed a line and found the end was not intact?

A

notify MRP and or IV nurse ASAP

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4
Q

What are the complications related to CVADs during insertion?

A
  • arrhythmia
  • Arterial puncture
  • Pneumothorax
  • Hemothorax
  • Hydrothorax
  • Injury to brachial nerve plexus
  • Cardiac perforation
  • Central vein perforation
  • Catheter migration/ malposition
  • Intolerance reaction
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4
Q

What are the complications related to CVADs post insertion?

A
  • Pulmonary embolism
  • Phlebitis
  • Infection
  • Total occlusion
  • partial occlusion
  • venous thrombosis
  • extravasation
  • infiltration
  • catheter fracture
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5
Q

What are the complications related to CVADs in regards to the insertion and post-insertion

A

air embolism

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6
Q

what are infusion-related complications for CVADs ?

A
  • circulatory overload
  • speed shock
  • allergic reactions
  • particulate matter
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7
Q

What are LOCAL signs and symptoms of infections for CVADs?

A

-redness
- tenderness
- purulent drainage
- warmth
- edema at the insertion site

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8
Q

what are systemic signs and symptoms of infections for CVADs?

A
  • fever
  • chills
  • malaise
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9
Q

what is used for the diagnosis of complications for CVADs?

A
  • increased temp
  • increased HR
  • increased RR
  • decreased BP
  • altered LOC
  • abnormal lab values (CBC, blood cultures, lactate)
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10
Q

How do you treat LOCAL infections for CVADs?

A
  • warm moist compresses
  • culture of drainage from site
  • catheter removal if indicated
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11
Q

How do you treat SYSTEMIC infections for CVADs?

A
  • IV fluids
  • antibiotics
  • sepsis protocols
  • catheter removed if indicated and tip sent to lab for culture
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12
Q

What is the role of the nurse when caring for a patient with a CVAD? What assessments and care are performed?

A
  • assess length
  • aspirate/ patency check
  • assess for pain
  • assess dressing
  • assess surrounding skin
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13
Q

What are the steps on how to change a PICC dressing?

A
  • Check VAD care/ maintenance protocol
  • Review policy for PICC dressing change
  • Wash hands
  • Gather supplies
  • Introduce self to pt, verify with 2 identifiers
  • Explain procedure
  • Assess pt comfort level
  • Wash hands
  • Open dressing tray/ get supplies organized
  • Don clean gloves
  • Place sterile drape
  • Instruct pt to face away from PICC arm
  • Pull dressing off starting at the top and working way down and boarders leave translucent part of dressing intact
  • Remove securement device
  • Cleanse skin
  • Secure lumen with new device
  • Place securement device on skin
  • Remove gloves/ clean hands
  • Put on sterile gloves
  • Use sterile forceps and remove remainder of dressing
  • Assess catheter length/ and site
  • Cleanse catheter site and surrounding skin
  • Apply dressing
  • Prime new needless cap/ replace old one
  • Assess all lumens for patency and flush with 10mL NS
  • Lock with heparin if required and close clamps
  • Clean up and document
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14
Q

What are the steps on how to collect a blood sample from a PICC?

A
  • Obtain verbal consent from client
  • Explain procedure/ if no refusal consider this consent
  • Gather supplies
  • Stop infusion for 2 minutes
  • Attach NS flush syringe tp proximal lumen
  • Check patency
  • Withdraw 5-6mL blood into empty syringe discard
  • Attach vacutainer fill to required volume repeat for as many vials as required
  • Remove vacutainer connector
  • Flush with 20mL NS
  • If unable to clear all blood form needless cap complete cap change
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15
Q

What are the steps on how to change a needless cap?

A
  • Gather supplies
  • Prep needless cap keeping it sterile
  • Attach NS syringe/ prime with NS
  • Scrub hub around old needless cap end with alcohol for 30 seconds
  • Allow alcohol to dry
  • Request client to turn head away from line
  • Remove old needless cap
  • Replace with primes new one
  • Complete patency check/ flush
  • Restart infusion
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16
Q

where is the tip of PVAD located?

A

periphery

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17
Q

where is the tip of CVAD located?

A

superior vena cava

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18
Q

Where is the location of the insertion site for a PVAD?

A

hand to elbow - distal veins of the arm or in foot

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19
Q

where is the location of the insertion site for a CVAD?

A

one of the following arteries:
- jugular
- cephalic
- basilic
- brachial
- subclavian
- femoral

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20
Q

What is the catheter dwell time for a PVAD?

A

change site Q 72-96hrs or prn

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21
Q

What is the catheter dwell time for CVADs?

A

PICC - 6 months to 1 year

central line
1. non-tunnelled 1 week
2. tunnelled up to 3 years
3. IVAD up to 5 years of # of punctures

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22
Q

what types of infusions can be done through a PVAD?

A

short term

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23
Q

what are the indications for a CVAD?

A
  • chemotherapy
  • long term
  • TPN
  • increased osmolality
  • decreased pH
  • higher irritant
  • blood products
  • obtain venous blood sample
  • monitor central venous pressure
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24
Q

What is the rate of infusion that can be used for PVADs?

A

depends on medication/ fluid

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25
Q

what is the rate of infusion that can be used for CVADs?

A
  • depends on medications/ fluids
  • can take 2-3L/ minutes
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26
Q

Who can insert a PVAD?

A
  • RN
  • LPN (in some places)
  • doctor
  • anesthetist
  • IV nurse
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27
Q

Who can insert a CVAD?

A

PICC - IV nurse
all other forms - surgeon while pt is under anesthetic

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28
Q

can you do blood sampling from a PVAD?

A

no

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29
Q

can you do blood sampling from a CVAD?

A

yes

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30
Q

can you do home IV therapy with a PVAD?

A

no

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31
Q

can you do home IV therapy with a CVAD? What are the types?

A

yes
- PICC
- IVAD
- hemodialysis line

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32
Q

what are the complication risks for PVADs?

A
  • infection
  • phelbitis
  • thrombophlebitis
  • fluid overload
  • arterial puncture
  • hemorrhage
  • extravasation
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33
Q

what are the complications for CVADs?

A

same as PVAD plus:
- air/ catheter embolism
- pneumothorax
- hemothorax
- arrhythmia
- horner’s syndrome

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34
Q

When do dressings need to be changed for PVADs?

A
  • prn
  • flush once/ shift if not infusing
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35
Q

When do dressings need to changed for CVADs?

A
  • Q7 days
  • prn
  • flush Q12hrs or Q24hrs at home
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36
Q

where is a PICC inserted?

A

periphery in the :
- cephalic
- basilic
- median cubital vein

37
Q

Where does the tip of the PICC rest?

A

lower portion of the distal superior vena cava

38
Q

who inserts a PICC and what do they use?

A

IV nurse by using an ultrasound to insert and must have a chest x-ray after to verify position prior to using

39
Q

how long can treatment last for a PICC?

A

1 month - 1 year

40
Q

what forms can a PICC come in?

A
  • valved
  • non-valved
  • single, double or triple lumen
41
Q

Can you take a BP on an arm with a PICC in it?

A

no

42
Q

What are CVADs that are non-tunnelled used for?

A

short term and emergent therapy

43
Q

how long can treatment with a non-tunnelled CVAD last for?

A

< 7 days due to infection but could be up to 1 month

44
Q

where is a non-tunnelled CVAD placed?

A

jugular or subclavian vein

45
Q

how is a non-tunnlled CVAD place?

A

surgically by physician and needs to be verified with chest x-ray prior to use

46
Q

why is a non-tunnelled CVAD sutured in place?

A

risk of bleeding if pulled out

47
Q

what are the potential lumen sizes for a non-tunnelled CVAD?

A

single, double or triple

48
Q

How long can a tunnelled CVAD be used for?

A

long term intermittently or continuously for more than 1 year

49
Q

How long can a tunnelled CVAD be placed for?

A

indefinitely if there are no complications

50
Q

how is a tunnelled CVAD placed?

A

surgically by physician and needs to be verified with a chest x-ray prior to use

51
Q

what is the purpose of a Dacron cuff for a tunnelled CVAD?

A
  • placed under skin
  • creates seal to keep catheter from slipping out
  • creates barrier from infection
52
Q

How many lumens does a tunnelled CVAD have?

A

single, double or triple

53
Q

what does IVAD stand for?

A

implanted vascular access device

54
Q

what is another name for an IVAD?

A

surgically implanted ports or port-a-cath

55
Q

what is a benefit of an IVAD?

A

decreased risk of infection for long term use

56
Q

how long can an IVAD be used for?

A

long term intermittent or continuous access usually more than 1 year

57
Q

describe the port on an IVAD

A

has reservoir with self sealing membrane and a catheter

58
Q

how is an IVAD inserted?

A

surgically by vascular physician into SC pocket of chest

59
Q

does an IVAD require a dressing when not in use?

A

no

60
Q

does an IVAD require a dressing when in use?

A

yes
- aseptic, transparent dressing over Huber needle, side and tubing

61
Q

who can access an IVAD?

A

HCP with further education

62
Q

when accessing an IVAD what are you assessing for?

A
  • site for dislodged port
  • dislodging of catheter
63
Q

if an IVAD port has dislodged what might you find?

A
  • free movement of port
  • swelling
  • difficulty accessing
64
Q

if an IVAD catheter tip has moved what might you find?

A
  • neck or ear pain
  • palpitations
65
Q

if an IVAD is not in use how often does it need to be flushed?

A

at least every 8 weeks

66
Q

does an IVAD require a heparin flush to maintain patency?

A

yes

67
Q

why is it preferred to take a blood sample from a PICC if someone has one instead now?

A
  • peripheral veins are no longer accessible or clinically significant reasons
  • needle phobia
  • client refusal
  • risk of hemorrhage
68
Q

are there any concerns around collecting a blood sample from a PICC?

A
  • increased risk of catheter related infections
  • CVAD occlusion
69
Q

Which lumen do you use from a PICC when collecting a blood sample?

A
  • largest lumen is best
  • in multi lumen red one is for blood
70
Q

when do you change a cap on a CVAD?

A

when blood is present in the cap and as per policy

71
Q

can a student collect a blood sample from a PICC?

A

yes with RN supervision

72
Q

How often should you assess a PICC/ CVAD?

A
  • every hour for a continuous infusion
  • every shift for saline locked
73
Q

What would you do if the CVAD/ PICC external length had a 4-9cm length difference?

A
  • stop infusion
  • notify IV nurse/ MRP
  • order X-ray to verify placement
74
Q

what are some risks associated to taking blood samples from a PICC?

A
  • hemolysis
    inaccurate coagulation studies if line locked with heparin
  • inaccurate therapeutic drug levels from medication admin
  • catheter related blood infection from access
75
Q

What are some benefits associated to taking blood samples from a PICC?

A
  • decrease risk of hematoma from venipuncture
  • vein preservation
  • decreased pain/ anxiety from needle phobia
76
Q

when should you change a PICC dressing?

A

dressing is:
- damp
- loosened
- visibly soiled
- moisture, drainage or blood present under dressing

77
Q

When should you change a needless cap?

A
  • Q4-7 days
  • when unable to clear blood from cap
  • sterility is compromised
  • following blood sampling
  • cap has been removed
78
Q

What do you use to clean a PICC dressing site?

A

2% chlorhexidine with alcohol

79
Q

What should a PICC dressing be labeled with?

A
  • date
    -time
  • initials of the nurse
80
Q

when removing a PICC dressing what direction do you do so in?

A

towards the insertion site

81
Q

What are some complications of a PICC dressing change?

A
  • migration
  • bleeding at site
  • introduction of contaminants leading to infection
  • accidental removal of PICC
82
Q

What are the steps for removing a PICC?

A
  • verify physicians orders
  • get patient to turn head away from PICC
  • grasp catheter at insertion site
  • withdraw slowly in 2-3cm increments
  • do not apply pressure directly over catheter
  • support surrounding tissue with sterile gauze
  • place sterile gauze and large transparent dressing over site
83
Q

What do you do if you feel resistance while removing a PICC?

A

stop and apply heat for 15 minutes to upper arm and shoulder then try again

84
Q

What are the steps for removing a jugular or subclavian line?

A
  • verify physician’s orders
  • practice val salsa with pt
  • position pt in transdelenburg without pillows and have them turn their head away
  • both pt and nurse should be wearing a mask
  • don sterile gloves
  • val salsa while drawing catheter and applying direct pressure over site with sterile gauze
  • normal breathing while apply pressure for 5-10 minutes without occluding carotid artery
  • place sterile/ large transparent dressing over site
85
Q

What do you do if you have resistance while removing a jugular or subclavian line?

A

stop, tape in place and report to MRP

86
Q

What do you do after post CVAD removal?

A
  • assess site q15 mins for 1hr then hourly for hemorrhage
  • monitor resp status q15mins for 1hr for SOB, PE
  • minimize pt activity for 1hr, 2hrs for femoral
87
Q

What do you do if you suspect an infection of the catheter?

A

cut off 1 inch of tip of catheter with sterile scissors and place in sterile C&S container, label, send to lab

88
Q

how many people do you need when collecting sample for suspected infection of catheter?

A

2 people

89
Q

how long do you hav to wait to remove CVAD dressing after line has been removed?

A

48hrs if no complications

NRSG 301 (5 decks)

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