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342 > CVC > Flashcards

CVC Flashcards

1
Q

What are 5 complications that may occur after a CVAD dressing change?

A
  • Risk of infection
  • Migration
  • Skin erosion
  • Infiltration
  • Extravasation
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2
Q

What should you assess prior to dressing change?

A
  • Redness or swelling
  • Old dressing
  • Suture secured in place for CVC
  • Measurement of external catheter
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3
Q

How should pt be positioned for dressing change?

A

Comfortable position, head slightly elevated and turned away from site

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4
Q

T or F:

Use clean gloves while cleaning the site.

A

F, use sterile. Clean are used to remove the old dressing.

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5
Q

What should you assess after changing the dressing on a CVAD?

A

The length of the external segment.

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6
Q

How often should a gauze dressing be changed?

A

Every 24-48 hours, earlier if soiled or wet.

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7
Q

How often should a transparent dressing be changed?

A

Every 7 days, earlier if soiled or wet.

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8
Q

What labs should you review before CVAD removal?

A

Platelets, PT, INR, PTT

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9
Q

Is the Valsalva maneuver necessary for PICC removal?

A

No

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10
Q

What 5 complications should you be aware of when removing a CVC?

A
  • Risk of pneumothorax
  • Hematoma
  • Air embolism
  • Thrombosis
  • Infection
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11
Q

Ideal position for removal of CVC?

A

10% down in Trendelenburg or Supine with head turned away from site

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12
Q

Ideal position for PICC removal?

A

Semi-Fowler’s with arm extended, face turned away

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13
Q

At what point during a CVC removal should you don sterile gloves?

A

After the dressing has been removed (clean gloves used for dressing removal)

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14
Q

How long should you apply pressure after removal?

A

1-5 minutes, longer if on anti-coags

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15
Q

How should the pt be positioned after removal? For how long? What are we monitoring for?

A

Pt should be lying flat for 30 minutes, monitor for S+S of air embolism

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16
Q

When a CVC is saline locked, how often should the patency be checked?

A

Every 24 hrs, should have brisk blood return and no resistance when flushing

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17
Q

T or F:

Clamp positions should be changed every 4-6 hrs.`

A

F, once per shift is fine.

18
Q

What are 3 reasons you might change the needle free connector?

A
  • Every 7 days it needs to be changed
  • If blood cannot be flushed out of connector
  • If it has been removed for whatever reason
19
Q

How often should tubing be changed?

A
  • Every 96 hours if continous

- Every 24 hours if intermittent or TPN/lipid infusion

20
Q

After giving a medication through a CVAD, how many mls should the line be flushed with?

A

10-20mls

21
Q

After drawing blood from a CVAD, how many mls should the line be flushed with?

A

20mls

22
Q

What type of dressing should be applied post CVAD removal? How long should this dressing stay in place?

A

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.

23
Q

Who may remove a tunneled or surgically implanted vascular access devices?

A

The physician

24
Q

What must be inspected immediately following removal of a CVAD?

A

The catheter tip for signs of breakage

25
Q

What should you do if resistence is met while removing a CVAD? Explain.

A

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.

26
Q

What should you do in the instance of peripheral venous catheter breakage?
(4)

A
  • 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
27
Q

What should you do in the instance of central venous catheter breakage?
(2)

A
  • Place patient in LEFT Trendelenburg.

- Notify a Physician immediately

28
Q

3 things to remember when sending a catheter tip for a C+S:

A
  • 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.
29
Q

If the external segment has an outward movement of _cm or more on an adult, what should be done?

A

5cm or more, the pt should have a chest xray done to confirm placement

30
Q

If the external segment has an outward movement of _cm or more on a child, what should be done?

A

1cm or more, the pt should have a chest xray done to confirm placement

31
Q

What should be done if the PICC migrates inward?

A

Pull it back to original placement

32
Q

T or F:

An xray to reconfirm PICC placement after pulling it back out to original position is not necessary.

A

T

33
Q

All lumens must be flushed at least every _ days.

A

7

34
Q

Non-valved PICCs are flushed every _ hrs.

A

24

35
Q

What should you do if a CVAD is occluded?

3

A
  • Reposition patient
  • Have patient cough and deep breathe
  • Raise patient’s arm overhead
36
Q

What should you do if a CVAD is infected?

3

A
  • Obtain blood cultures from peripheral and CVAD if
    ordered
  • Remove catheter
  • Replace catheter
37
Q

What should you do if a CVAD migrates?

3

A
  • Reposition under fluoroscopy
  • Remove catheter if ordered
  • Stop all fluid administration
38
Q

What should you do if a CVAD is causing skin erosion?

3

A
  • Remove CVAD as ordered
  • Improve nutrition
  • Provide skin care
39
Q

What should you do if a CVAD is causing infiltration/extravasation?
(4)

A 
- Apply cold/warm compresses according to specific 
  vesicant
- Obtain x-ray if ordered
- Use antidotes per protocol
- Discontinue IV solutions
40
Q

What should you do if a CVAD causes pneumothorax, hemothorax, air emboli, or hydrothorax?
(6)

A
  • 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

342 (7 decks)

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