cvc

Question 1

indications

Answer 1

TPN: (high [] glucose and dextrose, hypertonic)
chemo: vesicant and long term, danger if infiltration
long term abx (endocarditis)
loss of peripheral access

Question 2

non tunneled: general

Answer 2

deep lines
can have have things non-compatible, 3x lumen, superior VC is big turbulent BF
complications: air embolus, bleed, pneumothroax, CLABSI
1-5 ports, 7-10” long, CXR post op, no recommended dwelling time, short term (emergency), no home/ambulatory clinic
Subclavian (SC) -> insert at lung apex (risk of penumothorax with insertion - lung collapse)
internal jugular (IJ) -> no risk of lung puncture, straight into heart, nuisance (moistness and movement of neck)

Question 3

tunneled: general

Answer 3

surgeon, in OR, so they stay, cancer
hickman, groshong, broviac

Question 4

implantable ports: general

Answer 4

portacath or powerport
no external tubing
implantable venous access device

Question 5

peripherally inserted central cath: general

Answer 5

PICC
in R atrium or superior vena cava

Question 6

non tunneled care

Answer 6

can have have things non-compatible, 3x lumen, superior VC is big turbulent BF
complications: air embolus, bleed, pneumothroax, CLABSI
1-5 ports, 7-10” long, CXR post op, no recommended dwelling time, short term (emergency), no home/ambulatory clinic
removed by RN: check INR if on anticoags, supplies (sterile suture removal kit, sterile and clean gloves, occlusive dressing, measuring tape), explain procedure, supine or trendelenberg, valsalva (hum), apply P 3-5 min, occlusive dressing
measure L, cath tip culture

Question 7

IV cath dressings

Answer 7

state lock stabilize (wiggle means bigger hole, means more bacteria)
biopatch for CLABSI prevention

Question 8

tunneled care

Answer 8

through SQ tissue (stable!), in OR
used when infusion therapy in freq and prolonged (yrs)
advantaged: no needle sticks like implanted ports
disadvantages: prolonged break in skin integrity (implanted ports dont), irrigation protocol varies, may need heparin
site care
complications: cath damage, occlusion!, thrombosis, sepsis
removed by hcp

Question 9

implanted ports care

Answer 9

sx, under sq, use huber needle to access (no tubing if not in use so wont yank out)
for pt needing IV therapy >1yr, semi permanent
cath attached to port placed in pocket made in SQ tissue on chest wall
post op: closed incision
use non coring (huber) needle - 2000 in chest, 750 in upper arm
least impact on body image
irrigation protocol varies
site care: non when no accessed, change access needle weekly if ongoing infusion, clean/dress per protocol
complication: cath occlusion
removed by hcp, need incision to remove port

Question 10

PICC care

Answer 10

another non tunneled
median cubital vessel -> SVC, placed at antecubital fossa, basilic or cephalic vein
placed at bedside, certified RN, hcp, or radiologist
3-12 mo
no BP or blood draw (impair infusion)
decreased complications rates than other CVC: less microorganisms on arm, less insertion complications (pneumothorax - not sticky like around neck)
irrigation varies
site care: swab all caps with OH
site change day after insertion, then 1/wk, unless soiled
complications: phlebitis, cath occlusion
removed: by rn, lie or sit down, hand below heart, bear down, withdrawal inch by inch, ralx cath after each inch, dont pull if vein spasms (go slow), measure L