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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

air embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are infusion-related complications for CVADs ?

A
  • circulatory overload
  • speed shock
  • allergic reactions
  • particulate matter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are LOCAL signs and symptoms of infections for CVADs?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are systemic signs and symptoms of infections for CVADs?

A
  • fever
  • chills
  • malaise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat LOCAL infections for CVADs?

A
  • warm moist compresses
  • culture of drainage from site
  • catheter removal if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

where is the tip of PVAD located?

A

periphery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

where is the tip of CVAD located?

A

superior vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the catheter dwell time for a PVAD?

A

change site Q 72-96hrs or prn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what types of infusions can be done through a PVAD?

A

short term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
What is the rate of infusion that can be used for PVADs?
depends on medication/ fluid
25
what is the rate of infusion that can be used for CVADs?
- depends on medications/ fluids - can take 2-3L/ minutes
26
Who can insert a PVAD?
- RN - LPN (in some places) - doctor - anesthetist - IV nurse
27
Who can insert a CVAD?
PICC - IV nurse all other forms - surgeon while pt is under anesthetic
28
can you do blood sampling from a PVAD?
no
29
can you do blood sampling from a CVAD?
yes
30
can you do home IV therapy with a PVAD?
no
31
can you do home IV therapy with a CVAD? What are the types?
yes - PICC - IVAD - hemodialysis line
32
what are the complication risks for PVADs?
- infection - phelbitis - thrombophlebitis - fluid overload - arterial puncture - hemorrhage - extravasation
33
what are the complications for CVADs?
same as PVAD plus: - air/ catheter embolism - pneumothorax - hemothorax - arrhythmia - horner's syndrome
34
When do dressings need to be changed for PVADs?
- prn - flush once/ shift if not infusing
35
When do dressings need to changed for CVADs?
- Q7 days - prn - flush Q12hrs or Q24hrs at home
36
where is a PICC inserted?
periphery in the : - cephalic - basilic - median cubital vein
37
Where does the tip of the PICC rest?
lower portion of the distal superior vena cava
38
who inserts a PICC and what do they use?
IV nurse by using an ultrasound to insert and must have a chest x-ray after to verify position prior to using
39
how long can treatment last for a PICC?
1 month - 1 year
40
what forms can a PICC come in?
- valved - non-valved - single, double or triple lumen
41
Can you take a BP on an arm with a PICC in it?
no
42
What are CVADs that are non-tunnelled used for?
short term and emergent therapy
43
how long can treatment with a non-tunnelled CVAD last for?
< 7 days due to infection but could be up to 1 month
44
where is a non-tunnelled CVAD placed?
jugular or subclavian vein
45
how is a non-tunnlled CVAD place?
surgically by physician and needs to be verified with chest x-ray prior to use
46
why is a non-tunnelled CVAD sutured in place?
risk of bleeding if pulled out
47
what are the potential lumen sizes for a non-tunnelled CVAD?
single, double or triple
48
How long can a tunnelled CVAD be used for?
long term intermittently or continuously for more than 1 year
49
How long can a tunnelled CVAD be placed for?
indefinitely if there are no complications
50
how is a tunnelled CVAD placed?
surgically by physician and needs to be verified with a chest x-ray prior to use
51
what is the purpose of a Dacron cuff for a tunnelled CVAD?
- placed under skin - creates seal to keep catheter from slipping out - creates barrier from infection
52
How many lumens does a tunnelled CVAD have?
single, double or triple
53
what does IVAD stand for?
implanted vascular access device
54
what is another name for an IVAD?
surgically implanted ports or port-a-cath
55
what is a benefit of an IVAD?
decreased risk of infection for long term use
56
how long can an IVAD be used for?
long term intermittent or continuous access usually more than 1 year
57
describe the port on an IVAD
has reservoir with self sealing membrane and a catheter
58
how is an IVAD inserted?
surgically by vascular physician into SC pocket of chest
59
does an IVAD require a dressing when not in use?
no
60
does an IVAD require a dressing when in use?
yes - aseptic, transparent dressing over Huber needle, side and tubing
61
who can access an IVAD?
HCP with further education
62
when accessing an IVAD what are you assessing for?
- site for dislodged port - dislodging of catheter
63
if an IVAD port has dislodged what might you find?
- free movement of port - swelling - difficulty accessing
64
if an IVAD catheter tip has moved what might you find?
- neck or ear pain - palpitations
65
if an IVAD is not in use how often does it need to be flushed?
at least every 8 weeks
66
does an IVAD require a heparin flush to maintain patency?
yes
67
why is it preferred to take a blood sample from a PICC if someone has one instead now?
- peripheral veins are no longer accessible or clinically significant reasons - needle phobia - client refusal - risk of hemorrhage
68
are there any concerns around collecting a blood sample from a PICC?
- increased risk of catheter related infections - CVAD occlusion
69
Which lumen do you use from a PICC when collecting a blood sample?
- largest lumen is best - in multi lumen red one is for blood
70
when do you change a cap on a CVAD?
when blood is present in the cap and as per policy
71
can a student collect a blood sample from a PICC?
yes with RN supervision
72
How often should you assess a PICC/ CVAD?
- every hour for a continuous infusion - every shift for saline locked
73
What would you do if the CVAD/ PICC external length had a 4-9cm length difference?
- stop infusion - notify IV nurse/ MRP - order X-ray to verify placement
74
what are some risks associated to taking blood samples from a PICC?
- hemolysis inaccurate coagulation studies if line locked with heparin - inaccurate therapeutic drug levels from medication admin - catheter related blood infection from access
75
What are some benefits associated to taking blood samples from a PICC?
- decrease risk of hematoma from venipuncture - vein preservation - decreased pain/ anxiety from needle phobia
76
when should you change a PICC dressing?
dressing is: - damp - loosened - visibly soiled - moisture, drainage or blood present under dressing
77
When should you change a needless cap?
- Q4-7 days - when unable to clear blood from cap - sterility is compromised - following blood sampling - cap has been removed
78
What do you use to clean a PICC dressing site?
2% chlorhexidine with alcohol
79
What should a PICC dressing be labeled with?
- date -time - initials of the nurse
80
when removing a PICC dressing what direction do you do so in?
towards the insertion site
81
What are some complications of a PICC dressing change?
- migration - bleeding at site - introduction of contaminants leading to infection - accidental removal of PICC
82
What are the steps for removing a PICC?
- 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
What do you do if you feel resistance while removing a PICC?
stop and apply heat for 15 minutes to upper arm and shoulder then try again
84
What are the steps for removing a jugular or subclavian line?
- 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
What do you do if you have resistance while removing a jugular or subclavian line?
stop, tape in place and report to MRP
86
What do you do after post CVAD removal?
- 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
What do you do if you suspect an infection of the catheter?
cut off 1 inch of tip of catheter with sterile scissors and place in sterile C&S container, label, send to lab
88
how many people do you need when collecting sample for suspected infection of catheter?
2 people
89
how long do you hav to wait to remove CVAD dressing after line has been removed?
48hrs if no complications