CVC + Blood Draw Flashcards
3 Most common complications of using a CVC?
Fluid overload, septicemia, air embolism
What do these symptoms suggest? What do you do?
Sudden chest pain, difficulty breathing, decreased breath sounds, cessation of normal chest movement on one side, tachycardia and coughing
Pneumothorax
Remove CVC, give O2 by mask/nasal cannula, help the physician prepare for chest tube insertion with under water seal drainage system or a one way valve system (Heimlich valve).
What do these symptoms suggest? What do you do?
Sudden respiratory distress, decreased oxygen saturation levels, SOB, coughing, chest pain and decreased BP.
Air embolism
Verify that there is a cap on all lumens and that all are clamped (if it’s an un-valved CVC), check to see if the pt has pulled out their CVC, position client in left Trendelenburg, call the physician, give O2 and depending on severity of pt’s symptoms call a Code Blue
What do these symptoms suggest? What do you do?
Erythema, tenderness, induration or purulence within 2cm of skin at exit site
Infection
At exit site: apply warm compresses, daily site care, antibiotics
Call physician to notify assessment findings (using SBAR) request order from physician –
culture ? antibiotics ? And remove CVC if ordered by physician
How can reduce chance of infection with CVC’s
Better blood glucose control, use of sterile barrier precautions during insertion, timely replacement of IV tubing and add-on devices, application of IV site dressings, reduction in tubing access openings and strict aseptic technique.
How often do you need to change a CVC dressing
Gauze is every 48 hours
Transparent is every 7 days (for both when soiled or wet)
What position should the patient be placed on CVC removal
10 degree Trendelberg
How long must pressure be applied when removing a CVC
AT least 5mins (longer with anticoags)
What is the central complication during CVC removal? Prevention strategy?
Air emboli
o Prevent it by instructing pt to do the Valsalva maneuver (hold breath and bear down) or exhale (e-reserve article) while removing if Valsalva is contraindicated and instruct pt to remain in a supine position or semi-Fowlers (if not tolerated) for 30 minutes after removal (e-reserve article).
Nursing interventions and assessments during cvc removal
o Wash hands, apply gown, mask, goggles and clean (Then) sterile gloves to prevent infection.
o Cleanse the site following strict aseptic technique prior to removing the suture.
o Position pt correctly (Sup or Trend)
o Prevent and monitor for air emboli
- petroleum infused DRSG then 2x2’s
o Apply pressure for 5-10 minutes to prevent bleeding
o Apply occlusive drsg
o Inspect catheter integrity prior to discarding in biohazard waste.
o Send catheter tip for C and S if infection suspected or if Dr. ordered
-Keep pt supine for 30mins
-Change DRSG Q24h
DO you use peripheral or CVAD for blood draw
Critical components say:
Use peripheral unless- pt has ++ anxiety or difficult or more then 2 draws daily
Describe basic steps of blood draw
- Pause all infusions (1-5mins)
- distal lumen preffered
- Cleanse with OH at every step
- Aspirate and flush with 10 mLs (this syringe -can be used to pull discard blood)
- Remove cap and clean hub, connect empty -10ml syringe and remove and discard 5mls (3mls paeds).
- clean hub removed desired blood
- clean hub and connect primed cap and syringe for 20 mL flush
what swab supplies will you need for a CVC dressing change?
3 chlorohexadine.
Top of line (start from hub)
circles moving out
Bottom of line
Do you need sterile gloves for removing CVC
Yes, when it is sutured
What aseptic equipment clothing do you need for a CVC dressing change? CVC Removal?
For BOTH
Apparently a gown, mask and sterile gloves.
Gloves go on after old drug is removed.
