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3-Third semester > DONEskills exam 2- central lines > Flashcards

DONEskills exam 2- central lines Flashcards

1
Q

What is a Central Venous Assess Device (CVAD)?

tube
ends up where

A

Tube passed through a vein to end up in the vena cava or in the right atrium.

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2
Q

Why would a patient need CVAD

long
needs
monitoring of
T
self
__peripheral veins
limited

A

Long-term IV therapy

Need frequent access (blood samples)

CVP monitoring

TPN

Self-Administration of IV therapy

Sclerosed peripheral veins

Limited peripheral access

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3
Q

Hickman, Broviac:

open
what’s used

Central Lines (single of multiple lumens
CVAD: Types

A

Open ended devices with a catheter tip that is open like a “straw”.

Heparin used

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4
Q

Groshong

what type of catheter
pressure /prevents
use of

Central Lines (single of multiple lumens
CVAD: Types

A

: Valve ended catheter

; pressure activated valve that prevents blood reflux.

(use ns)

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5
Q

what inserted catheter
where inserted
what’s used

PICC (single or multiple lumens):
CVAD: Types

A

Peripherally inserted catheter;

basilic or cephalic vein

Heparin used

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6
Q

Implanted port (also called Powerport or Mediport

where put

what maintains patency

CVAD: Types

A

Surgically implanted under skin in subcutaneous pocket on chest

Heparin/0.9% NS utilized to maintain patency

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7
Q

What should I know?

is it
how many
is the
is the
where does
is it
where does
when was

A

Is it implanted or external?

How many ports/lumens does it have?

Is the tip open or valved?

Is the external tunneled or non-tunneled?

Where does the tip end?

Is it designed for dialysis or not?

Where does the tip come out?

When was the catheter placed?

Last dressing/cap change? Last flush?

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8
Q

where does central line enter venous system

x4

A

Subclavian Vein

Internal Jugular Vein

External Jugular Vein

Femoral Vein

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9
Q

where does picc enter venous system

A

Basilic Vein

Cephalic Vein

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10
Q

when will it end if using femoral vein

A

inferior vena cava

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11
Q

subclavian

is itdesirable

why

A

not desirable

Why?High incidence of complications

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12
Q

where will these normally end up-

best is-

true-

A

Superior Vena Cava

Best is at right atrial junction

True CL placement

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13
Q

what do you need to do before using central line

can rn read X-ray

what need before using

A

All central lines must be confirmed with X-ray before use!

Rn cannot read the xray- but need the xray to confirm its correct before usage

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14
Q

RN Responsibilities include

monitor what
use what
change dressing how often
assess before what
respond
assisting with
who can insert pics

A

Monitor & Assess CVL, PICC, and implanted ports

Use STERILE technique! (sterile gloves)

Change dressings(q7days), change caps (q7days or after blood draw), and flush per protocols

Access CVL, PICC and implanted ports for medication administration, blood draw, and IV infusions

Respond to any adverse situations related to these devices

Assisting with placing CVL and implanted ports (surgical)

PICC certified nurses can insert PICCs under Ultrsound guided!

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15
Q

Assessment of the CVAD includes:

trace where
assess
monitor
assess what
asses for any
always do what

A

Trace line(s)-bag to pump to line

Assess site, dressing, caps

Monitor for any s/s infection

Assess patency

Assess for any potential complications

Always look at patient! How do they look?

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16
Q

Central Line Dressing Change

how often

patient lays how-wears what as well

with gloves do what

put on what

cleanse w/

cover w/

might have

A

Usually changed 5-7days (per agency policy)

Patient should lay on back and turn head away (can wear mask)

With clean gloves, remove old drsg

Put on Sterile gloves

Cleanse with chloraprep for at least 30 seconds

Cover with sterile dressing and biopatch, depending on agency policy

Might have small gauze if recently inserted.

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17
Q

Infusion via Central lines

the hub
attach
__lumen
aspirate
instill//maintain
do what before removing syringe
the hub again
connect
__lumen
pump
remember

A

Scrub the hub

Attach 10 ml saline syringe

Unclamp lumen

Aspirate for blood return

Instill saline slowly, approximately 5 ml-Maintain positive pressure!

Clamp catheter before removing syringe

Scrub the hub again

Connect IV fluids, unclamp lumen, set pump.

Remember to trace your line.

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18
Q

Administration of medications via central lines

same as what
except need(x2)

A

Same procedure

except you always need at least a 10ml syringe and you may need to use the SASH method:

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19
Q

SASH method

A

saline
administration
saline
heparin

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20
Q

why always use a 10 ml syringe

A

always use a 10 ml or larger syrnge when apritating- anything smaller may collapse catheter

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21
Q

Managing Ports

brown
red
white

A

Brown (usually largest) – Use for blood administration

Red – use for blood draw

White – TPN or IV fluids

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22
Q

what to do with a port when withdrawing blood

A

Stop all infusions when withdrawing blood becayse it may scew results

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23
Q

PICC: Assisting in insertion

put patient in what

place what//turn where

maintain

watch what for what

A

Patient in Trendelenburg

Place mask on pt and turn pt’s head away from side of venipuncture.

Maintain sterility.

Nurse watches the ecg to make sure pt doesn’t go into lethal rythmm

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24
Q

why put the patient in trendelenerg

A

(to prevent air embolism and help distend subclavian and jugular veins).

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25
Q

What should you do when a PICC pulls out even a small amount?

do not
notify
what again

A

Do NOT push a PICC line back in

Notify physician

x-ray again to verify

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26
Q

PICC line removal

verify
put pt where
hh/ppe
remove
sterile
hold //to
what do they do//what you do
what type of motion
apply
inspect
remain for how ling

A

Verify order

Supine flat or 10 degree

Hand hygiene, PPE

Remove old dressing

Sterile gloves, sterile dressing kit and suture removal supplies

Hold 4x4 gauze to site-sterile

Deep breath (them)and Valsalva maneuver as catheter is removed

Smooth, continuous motion, immediate pressure at site

Apply sterile occlusive dressing

Inspect tip intactness and length

Remain in supine position for 30 minutes

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27
Q

Implanted port (Mediport or Portacath)

placed where
enters
accessed with//remains for how long
newer ports are
used for

A

Surgically placed under skin in SQ pocket

Attached catheter enters superior vena cava

Accessed with special needle, non-cored (Huber) which can remain in place for 7 days

Newer ports are MRI/CT compatible (POWERPORTS)

Used for long-term (Chemotherapy

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28
Q

Implanted port (Mediport or Portacath)
__site
attach__
__device
insert
withdraw
f
close
flush w/

A

Scrub site,

Attach 10 ml saline syringe to Huber needle,

flush device

Insert needle,

withdraw blood,

flush

Close clamp

, flush with heparin or attach to fluids

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29
Q

Air embolism:
what position-turn where-does what

adminsister

call/put

monitor for

Potential Complications with CVAD

A

Trendelenburg position, turned to left(in suspected and confirmed)(prevents air from rising to brain)

Administer 02 via non-rebreather at 15 ml

Call rapid response immediately-put patient in hyperbaric chamber

Monitor for Respiratory Distress, BP, Pulse

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30
Q

air embolism prevention

always have

c and use

no what should ever be in

A

Always have pt. perform Valsalva’s maneuver;

clamp and use positive pressure

-no air should ever be in anything that you are pushing in catheter

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31
Q

Infection:
prevention:
keep clients
can shower but

Potential Complications with CVAD

A

Prevention: Wash hands, maintain sterile technique!-use sterile awlays

Keep clients head turned away when accessing or changing dressing

Can shower but need to cover appropraitly

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32
Q

Dysrhythmia:
assess for
if Cath is rubbing-causes
watch

Potential Complications with CVAD

A

Assess patient for any palpitations/chest pain

If cath is in right place but rubbing against the wall it can cause life threatening dysrhythmias

Watch monitor always

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33
Q

Catheter dislodgement –
stop
notify
get

Potential Complications with CVAD

A

stop all infusions,

notify md,

get xray

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34
Q

Catheter occlusion:
prevention-use
if not working use

Potential Complications with CVAD

A

Prevention: Use Push-Pause and flush protocols

Might be able to use Alteplase (ATP) if not working

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35
Q

hypertonic solution contains

a
c
g
v
e
w
others-

A

Amino acids

Carbohydrates—10-35%

glucose

Vitamins

Electrolytes

Water

Others: insulin

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36
Q

Special Solutions: TPN

must have

store until

ensure

change every

ensure proper rate to prevent

monitor

A

must have a CVAD

Store in fridge until 30 minutes before use

Ensure patency of central line

Change tubing, filter, and solution every 24 hrs

Ensure proper rate to prevent complications (seizure, coma)

Monitor Blood Glucose

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37
Q

Monitoring TPN

last resort when

how much weight gain

monitor levels of 2

monitor blood

monitor tests

use what for infusion

A

Given as a last resort when patients cannot tolerate food and need it through iv

Weight gain 1-2 pounds/week expected

Monitor electrolyte and protein levels

Monitor Blood glucose

Monitor kidney and liver blood tests

Use filter for infusion—check policy

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38
Q

Complications: TPN

4

A

Air embolism

Hyperglycemia

Hypoglycemia

Catheter related infection

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39
Q

Lipids

may-use
change how often
baseline what
start
% of solution
what’s required

A

May piggyback into TPN: use closest port to client below tubing filter

Change tubing and solution every 24 hours (per agency protocol)

Baseline VS in case of rxn

Start slow at first 1mL/minute for adults

10%-20% solution

Special tubing required

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40
Q

side effects of lipids
c
fx2
dx2

A

Chills

Fever

Flushing

Diaphoresis

Dyspnea

41
Q

cvad dressing change

determine
e/p/c/2
gather wash
put on
remove while
inspect
remove
open
put on
akin
apply
apply
apply
label w/
d/d

A

determine need for dressing change

explain, privacy, culture, 2 identifiers ,

gather equipment and wash hands

put on mask on you and pt and gloves

remove old dressing while stabilizing

insepct site for complications

remove gloves

open chad kit and maintain sterile technique

put on sterile gloves

skin antisepsis

apply skin prep

apply bio patch

apply sterile tegaderm

label with date, time , initials

dispose/ document

42
Q

cvad blood draw

verify
I/e/p/c
pause
perform
clean port-1st
clean port2nd
use
clean port 3rd
clean port 4th
prime/attach

A

verify amount with lab

identify/expain/ provacy/ cultural

pause the pump

perform hand hygiene and gloves

clean port you are using/connect empty 10 ml syringe and aspirate 4-5ml/ clamp Cath, remove syringe, discard

scurb for 15/ attach 10 ml syringe - unclamp, withdraw blood , clamp, remove syringe

use transfer device and label each device

scrub for 15 seconds- attach 10 ml normal saline, flush 3-5, push pause and clamp

scrub for 15- flush with heparin, push pause, clamp,

prime new lumen cap with ns and replace cap ///attach lumen and take off ns

43
Q

managing chest tube drainage systems

safety precautions-

select

prepare according

assess and maintain by

A

safety precautions-orders/alergies/ wash hands / apply ppe/ assess vs/ meds/hh/privacy cultural needs

select- equipment, supplies and material

prepare according- assess system needed- either water seal or waterless seal

assess and maintain by-assesing vs, assessing pain, clean gloves, checking surrounding, check drainagie tubing, keep drainage system upright, secure w/ tape, maintain suction control

44
Q

assisting with removal of chest tube-

hh and what
assist w/
what to patient
put pt where

A

hand hygiene and time out

assist with health care provider as they remove tube

support paitent and put into upright poition.

45
Q

autotransfusion of chest tube drainage

hh
system set up-acording to
prepare
reinfuse
help pt

A

-hand hygiene

system set up- according to the steps to keep sterility, make sure its tight and clamps are open

prepare chest drainage for infusion

reinfuse chest drainage

help patient in comfortable position

46
Q

infuse iv meds where when giving parenteral

can you interrupt parenteral

A

infuse iv meds in alterntive site when giving parenteral nutrition

Do not interrupt cpn for anything and make sure it does not exceed rate

47
Q

Administer parenteral nutrition-

h/h
bag//check
identify
clean__
__solution
scrub
flush
remove
connect

A

hand hygiene,

check/inspect cpn bag and check iv solution,

identify patient usinf indefiiers,

clean gloves,

prime solution

, scrub alchohol swab,

normal saline flush,

remove syninge

connect CPN,

48
Q

Repsitory system in shock-

A

impaired oxygen delivery causes a drop in blood volume

o2 carrying RBCs.

49
Q

GI/gu in shock-

causes what
during shock
long term

A

cuases gastric ulcers 2-10 days after shock.

During shock, motility is impaired and paralytic ileus

if long term- necrosis of organs

50
Q

Nuerologic system in shock-

A

change in mental status and orientation

51
Q

Renal system in shock-

A

urine output is reduced

52
Q

Effects on Skin,

Temperature,

Thirst-

shock

A

changes in skin color,

body temp decreases,

decreases in metabolism

53
Q

Pleura

what kind of membrane

covers what

2 layers do what//creates

A

double layered membrane

covers lungs and inside of thoracic cavities

2 layers cling together hold lungs to thoracic wall and creates negative pressure in pleural space

54
Q

pleura functions

provides

allows

A

provides serous fluid

allows lungs to move easily over thoracic wall during breathing

55
Q

Bronchioles-

air

during inspiration
during expiration

A

Air moves into air sacs-

During inspiration air enters through bronchus and moves to smaller passageways of lungs to alveoli,

CO2 expelled on expiration

56
Q

Alveoli

exchange of what

contains what

A

gas exchange,

contain a surfactant

57
Q

what is surfancant

fluid
decreases//so

A

fluid to keep moist

decrease surface tension so lungs don’t collapse)

58
Q

Tidal volume

A

-amount of air moved in and out of lungs with each normal breath

59
Q

Pleural Effusion

collection of what where
from what

A

Collection of excess fluid in pleural space,

from systemic or local disease (CHF)

60
Q

Empyema
Pleural Effusion

A

-pus in pleural cavity

61
Q

Hemorrhagic
Pleural Effusion

A

-mix blood and pleural fluid

62
Q

what does Large Pleural effusion do

and what does it cause

A

compresses lung tissue

(dyspnea

63
Q

Pneumothorax

air where
___pressure
what’s impaired
natural recoil causes what

A

Air in pleural space

equalizes pressure,

lung expansion impaired

natural recoil tendency of the lung causes it to collapse

64
Q

Spontaneous pneumothorax-

when what ruptures
allows
air does what

A

when air filled bleb (blister) on lung surface ruptures

Allows air from airways to enter pleural space

Air accumulates until pressures are equalized

65
Q

Primary spontaneous pneumo

occurs when
cause is

A
  • occurs in previously healthy people, tall slender men ages 16-24,

cause unknown

66
Q

Secondary spotaneous pneumo

over
more
usually d/t

A

over distention and rupture of an alveolus,

more serious or life threatening

(usually d/t lung condition)

67
Q

s/s of spontaneous pneumo-

what pain
what at rest
what increased
chest wall

A

pleuritic chest pain

, sob at rest,

RR and HR increased,

chest wall movement asymmetrical (less movement on affected side than on unaffected)

68
Q

Placement of a closed-chest catheter

allows
must be
prevents//creating

A

allow lung to re-expand

must be sealed if used to remove air/fliud

prevents air from also entering the tube and creating an open pneumothorax

69
Q

chest tube sealed with what

or connected to what

A

CT sealed with heimlich valve (one-way)

or connected to a closed drainage system with water seal

70
Q

water seal prevents what

and what else

A

Water seal prevents air from entering chest cavity during inspiration

air to escape during expiration

71
Q

why Low level of suction to system

helps
what occurs

A

helps to re-establish negative pressure in pleural space

(re-expansion occurs)

72
Q

Chest Tubes placement

who does it
what is rn responsible for

A

By MD in Emergency situation or in surgical area

RN responsible for equipment working and ready, assessment of system and site, and assisting with insertion as MD requests

73
Q

Chest tube Usually placed due to

p
h
f c
p c
t p

A

Pneumothorax

Hemothorax

Flail chest

Pulmonary contusion

Tension pneumothorax

74
Q

Purpose of Chest Tubes

allows
drains

A

Allows for re-expansion of lungs

Drains blood or other fluids

75
Q

multiple tubes chest tubes

why place in upper/medial

why place in lower lobe

A

Surgery might place a tube in the upper or medial lobe(s) for re-expansion

in the lower lobes for drainage

76
Q

rn during insertion
c
s
p

A

Consent/

Supplies/

Position

77
Q

Rn after procedure of chest tube

assess how often

have pt do what//nurse do what as well

check system why

A

Assess respiration status every 4 hrs,

have patient take deep breathes (if painful pre-medicate)

check the system to ensure that drainage is patent and that the tubing is free of dependent loops or kinks

78
Q

after procedure

maintain
tape why
keep what where
dressing

A

Maintain closed system

Tape all connections and ensure they are secure with each assessment

Keep collection apparatus below level of chest (drains d/t gravity)

Dressing change depending on agency policy

79
Q

rn role with chest tube

checking
check what
assist with what

A

Check for kinks

Check water seal frequently

Assist with applying sterile occlusive dressing (most MDs use petroleum jelly based, but research doesn’t indicate this is necessary)

80
Q

drainage should not exceed how much in 24 hrs

A

Drainage should not exceed 500 cc in first 24 hours

81
Q

When assisting with removal

pt do what
nurse do what

A

Pt to exhale and bear down;

place sterile dressing immediately over site

82
Q

what’s in first collection chamber

this is connected to what

which is connected to what

A

Chest Tube drainage

connected to a water seal chamber,

connected to the suction control chamber

83
Q

Chamber 1

type of system
used for
collects

A

Closed system

Used for restoring intrapleural pressure to reinflate lung

Collects fluid from the patient

84
Q

Chamber 2
what seal
must be
prevents/allows

A

Water seal

Must be filled at appropriate level with sterile water

Prevents air from entering chest cavity during inspiration and allows air to exit on expiration

85
Q

chamber 2:

should have
not what
during set up:
if not bubbling-

A

Should have intermittent bubbling;

not large amount of bubbling

, during set up adjust suction until bubbling in the suction control chamber is noted

If not bubbling check for kinks in tubing.

86
Q

Chamber 3
what control
set
wants different about this and 2

A

Suction control

Set to prescribed setting

Same as 2 system setup only with suction being third chamber

87
Q

Is there extreme bubbling in the water chamber

check for
check what
do what

A

if so check for leaks…

Check insertion site, tubing and drainage system

pinching at each level to see if bubbling stops. IF stops this is where the leak is

88
Q

Milk tubing when

what does

A

ONLY with MD order.

Can increase negative pressure in intrapleural space

89
Q

what does it mean when there is no fluctuating is water seal chamber

A

something is obstructing tubing check for kinks

90
Q

Dressings and clamps

what dressing
what in emergency

A

Sterile Vaseline dressing

Padded clamps at bedside for emergency

91
Q

Positioning of tubes and collection device

what allows drainange
secure system where//does what
have what at bedside
what prevents dislodgment

A

Minimum to no coiling to allow for drainage

Secure system below patient to prevent tipping and adequate drainage

Have emergency backup system and sterile water at beside

TAPE ALL CONNECTIONS to prevent dislodgement

92
Q

Assess system
how often
should remain
avoid

A

Assess every 2-4 hours

Should remain patent and intact (sterile)

Avoid tension on tube with positioning

93
Q

Respiratory Status

every when
water seal
what should not be present

A

Q 4 hrs

Water seal should fluctuate with respiratory effort

Subcutaneous air should NOT be present=palpate around site

94
Q

Drainage-keep

when is it removed

A

Keep tubing free of kinks

Removed usually when drainage is less than 50-100ml in 24 hours

95
Q

Bubbling with suction

A

Can be intermittent or continuous (not excessive

96
Q

If chest tube dislodges

do what immediately
while pt does what
lung
call

A

Cover with sterile Vaseline/Petrolatum gauze (nonporous) IMMEDIATELY

while you have the patient exhale

Auscultate lung sounds

Call physician and anticipate the need for a stat X-ray

97
Q

If the drainage system is disconnected from the patient

do what to tube
place
lungs
call

A

Clamp tube near insertion site

Place end of tube in sterile water

Auscultate lung sounds

Call physician and anticipate the need for a stat X-ray

98
Q

When is it time to Discontinue a Chest Tube?

if for drainage-
if for tension pneumo-

A

, physician will consider removing when drainage is minimal (i.e. a patient with a hemothorax)

when the x-ray shows the lung re-inflated

3-Third semester (13 decks)

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