CVC's Flashcards
Where is location of CVC catheter tip
the lower third of the superior vena cava and the junction of the right atrium. CAVOATRIAL
Reasons you might use CVC of peripheral IV
To monitor central venous pressure in ill patients
To rapidly administer IV fluids
To administer drugs and/or chemotherapy
To administer blood products
To administer TPN
To monitor post-op patients
To assist in the diagnosis of
cardiac failure
For long-term therapy when a patient’s veins are poor/limited
To administer multiple incompatible medications simultaneously
4 types of CVC
- Percutaneous Non tunnelled (Yer standard Short-Term /long term) e.g. CVC
- Tunneled/ Non- tunneled e.g. Hickman(tunneled)
- Peripherally Inserted Central Catheter e.g. PICC
- Implanted Venous Port e.g. Portacath
Characteristics of percataneous CVC
Inserted through the Subclavian Vein, Jugular Vein, Femoral Vein .
Used for short-term therapy, days to several weeks
Can be single, double or triple lumen
Not surgically inserted
Held in place with sutures
Clamps preset ,Non valve(close when flushing /changing caps)
Characteristics of Hickman CVC
AKA externally tunnelled
Used for long-term ( considered permanent)
Inserted in the chest region: subclavian or jugular vein
Surgically inserted
Held in place by a Dacron cuff coated in antimicrobial solution. (under skin)
Characteristics of PICC
- Can be used for days to months
- Some types have a special one-way valve called a “Groshong Valve” that negates the need for heparinization (see pt’s specific care plan)
- inserted into the antecubital fossa or the upper arm (basillic or cephalic) and advanced to reach the superior Vena Cava
- Not surgically inserted
- Held in place with sutures or manufactures’ securement device
Characteristics of implanted venous ports
Used for long-term therapy(permanent)
Inserted into the chest ,abdomen or inner aspect of the arm
Requires surgery to be inserted( catheter inserted via the subclavian or jugular and attached to reservoir located within the subcutaneous pocket)
No external lumens, once inserted require minimal nursing care
Need to access with a special noncoring needle(Huber) using sterile technique
For example : Portacath
Name another IV set up that isn’t quite a CVC
Peripheral MIDLINE
- Common use in Island Health
- offer an all in one insertion mechanism with an integrated guide wire to assist with difficult insertions
- The device has a dwell time of 4 weeks
- Flushing: with 10mLs N/S Q8h to maintain patency and before and after each use
- dressing change :Q 7 days for transparent dressing and q 48 hours if gauze dressing is applied
- Check the care plan
Patient assessment prior to CVAD insertion
*Understand why the patient needs a CVC
Review the order for CVAS accuracy and completeness
Assess pt.’s hydration status, allergy for iodine/chlorhexidine
Assesse for any surgical procedures in the upper chest or any anatomic irregularities of the proposed site
Obtain a Consent form
Assess patient understandings of CVADs ; knowledge of purpose, care &; maintenance.
Xray order
Fluid status, resp assessment
What is the Valsalva maneuver? why do it?
Just before time of insertion, ask patient to hold breath and strain. This increases central venous pressure to prevent entry of air into the catheter
Important considerations changing an injection cap
Clamp however possible
Valsalva maneuver
flush with saline
Slide says to cleanse w/ antiseptic out of wrapper (its sterile.. no?)
Monitor, assess document
Procedure for CVC flush
Use ASASH
Aspirate ,Saline, Administer Medications ,Saline, heparin
Factors to consider when choosing to use CVAD
Many factors are considered before placement of a CVAD such as
pH and osmolarity of the solution or medication (pH less than 5.0 or greater than 9.0, osmolarity greater than 600 mOsm/L) to be administered,
Duration of therapy (greater than 7 days),
Status of veins for short peripheral access
Disease process (e.g., cancer, pain management)
CVC what is required pre and post insertion from nursing?
Complications post?
pre- informed consent
Post- complications and Tip location documentation
Complications Subcutaneous emphysema Bleeding Air embolus Pneumothorax
How often is a CVC drsg changed
Q7days or PRN
