CVC Flashcards
What are 5 complications that may occur after a CVAD dressing change?
- Risk of infection
- Migration
- Skin erosion
- Infiltration
- Extravasation
What should you assess prior to dressing change?
- Redness or swelling
- Old dressing
- Suture secured in place for CVC
- Measurement of external catheter
How should pt be positioned for dressing change?
Comfortable position, head slightly elevated and turned away from site
T or F:
Use clean gloves while cleaning the site.
F, use sterile. Clean are used to remove the old dressing.
What should you assess after changing the dressing on a CVAD?
The length of the external segment.
How often should a gauze dressing be changed?
Every 24-48 hours, earlier if soiled or wet.
How often should a transparent dressing be changed?
Every 7 days, earlier if soiled or wet.
What labs should you review before CVAD removal?
Platelets, PT, INR, PTT
Is the Valsalva maneuver necessary for PICC removal?
No
What 5 complications should you be aware of when removing a CVC?
- Risk of pneumothorax
- Hematoma
- Air embolism
- Thrombosis
- Infection
Ideal position for removal of CVC?
10% down in Trendelenburg or Supine with head turned away from site
Ideal position for PICC removal?
Semi-Fowler’s with arm extended, face turned away
At what point during a CVC removal should you don sterile gloves?
After the dressing has been removed (clean gloves used for dressing removal)
How long should you apply pressure after removal?
1-5 minutes, longer if on anti-coags
How should the pt be positioned after removal? For how long? What are we monitoring for?
Pt should be lying flat for 30 minutes, monitor for S+S of air embolism
When a CVC is saline locked, how often should the patency be checked?
Every 24 hrs, should have brisk blood return and no resistance when flushing
T or F:
Clamp positions should be changed every 4-6 hrs.`
F, once per shift is fine.
What are 3 reasons you might change the needle free connector?
- Every 7 days it needs to be changed
- If blood cannot be flushed out of connector
- If it has been removed for whatever reason
How often should tubing be changed?
- Every 96 hours if continous
- Every 24 hours if intermittent or TPN/lipid infusion
After giving a medication through a CVAD, how many mls should the line be flushed with?
10-20mls
After drawing blood from a CVAD, how many mls should the line be flushed with?
20mls
What type of dressing should be applied post CVAD removal? How long should this dressing stay in place?
An occlusive dressing ( e.g. petroleum impregnated gauze), at site followed by gauze and transparent dressing, must remain in place x 24 hour to prevent risks of air embolism and infection.
Who may remove a tunneled or surgically implanted vascular access devices?
The physician
What must be inspected immediately following removal of a CVAD?
The catheter tip for signs of breakage
What should you do if resistence is met while removing a CVAD? Explain.
Stop, reapply a sterile dressing and notify the physician. The resistance may be due to catheter breakage and puts the pt at risk for catheter embolus.
What should you do in the instance of peripheral venous catheter breakage?
(4)
- Apply a tourniquet high on the limb
- Keep the limb still and below the level of the heart
- Ensure a peripheral pulse in the limb is present
- Notify the Physician
What should you do in the instance of central venous catheter breakage?
(2)
- Place patient in LEFT Trendelenburg.
- Notify a Physician immediately
3 things to remember when sending a catheter tip for a C+S:
- Cleanse the insertion site prior to removal.
- Avoid dragging the tip along the skin during removal.
- Cut 2 inches (5cm) off with sterile scissors and place in a sterile Culture and Sensitivity container.
- NOTE: Specimen may NOT be processed if greater than 5cm of catheter is sent.
If the external segment has an outward movement of _cm or more on an adult, what should be done?
5cm or more, the pt should have a chest xray done to confirm placement
If the external segment has an outward movement of _cm or more on a child, what should be done?
1cm or more, the pt should have a chest xray done to confirm placement
What should be done if the PICC migrates inward?
Pull it back to original placement
T or F:
An xray to reconfirm PICC placement after pulling it back out to original position is not necessary.
T
All lumens must be flushed at least every _ days.
7
Non-valved PICCs are flushed every _ hrs.
24
What should you do if a CVAD is occluded?
3
- Reposition patient
- Have patient cough and deep breathe
- Raise patient’s arm overhead
What should you do if a CVAD is infected?
3
- Obtain blood cultures from peripheral and CVAD if
ordered - Remove catheter
- Replace catheter
What should you do if a CVAD migrates?
3
- Reposition under fluoroscopy
- Remove catheter if ordered
- Stop all fluid administration
What should you do if a CVAD is causing skin erosion?
3
- Remove CVAD as ordered
- Improve nutrition
- Provide skin care
What should you do if a CVAD is causing infiltration/extravasation?
(4)
- Apply cold/warm compresses according to specific vesicant - Obtain x-ray if ordered - Use antidotes per protocol - Discontinue IV solutions
What should you do if a CVAD causes pneumothorax, hemothorax, air emboli, or hydrothorax?
(6)
- Administer oxygen
- Elevate feet.
- Aspirate air, fluid
- If air emboli suspected, place patient on left side with
head down. - Remove catheter as ordered
- Help with insertion of chest tubes as ordered
