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D-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
What should you do when a PICC pulls out even a small amount? do not notify what again
Do NOT push a PICC line back in Notify physician x-ray again to verify
26
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
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
27
Implanted port (Mediport or Portacath) placed where enters accessed with//remains for how long newer ports are used for
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
28
Implanted port (Mediport or Portacath) __site attach__ __device insert withdraw f close flush w/
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
29
Air embolism: what position-turn where-does what adminsister call/put monitor for Potential Complications with CVAD
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
30
air embolism prevention always have c and use no what should ever be in
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
31
Infection: prevention: keep clients can shower but Potential Complications with CVAD
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
32
Dysrhythmia: assess for if Cath is rubbing-causes watch Potential Complications with CVAD
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
33
Catheter dislodgement – stop notify get Potential Complications with CVAD
stop all infusions, notify md, get xray
34
Catheter occlusion: prevention-use if not working use Potential Complications with CVAD
Prevention: Use Push-Pause and flush protocols Might be able to use Alteplase (ATP) if not working
35
hypertonic solution contains a c g v e w others-
Amino acids Carbohydrates—10-35% glucose Vitamins Electrolytes Water Others: insulin
36
Special Solutions: TPN must have store until ensure change every ensure proper rate to prevent monitor
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
37
Monitoring TPN last resort when how much weight gain monitor levels of 2 monitor blood monitor tests use what for infusion
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
38
Complications: TPN 4
Air embolism Hyperglycemia Hypoglycemia Catheter related infection
39
Lipids may-use change how often baseline what start % of solution what's required
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
40
side effects of lipids c fx2 dx2
Chills Fever Flushing Diaphoresis Dyspnea
41
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
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
cvad blood draw verify I/e/p/c pause perform clean port-1st clean port2nd use clean port 3rd clean port 4th prime/attach
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
managing chest tube drainage systems safety precautions- select prepare according assess and maintain by
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
assisting with removal of chest tube- hh and what assist w/ what to patient put pt where
hand hygiene and time out assist with health care provider as they remove tube support paitent and put into upright poition.
45
autotransfusion of chest tube drainage hh system set up-acording to prepare reinfuse help pt
-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
infuse iv meds where when giving parenteral can you interrupt parenteral
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
Administer parenteral nutrition- h/h bag//check identify clean__ __solution scrub flush remove connect
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
Repsitory system in shock-
impaired oxygen delivery causes a drop in blood volume o2 carrying RBCs.
49
GI/gu in shock- causes what during shock long term
cuases gastric ulcers 2-10 days after shock. During shock, motility is impaired and paralytic ileus if long term- necrosis of organs
50
Nuerologic system in shock-
change in mental status and orientation
51
Renal system in shock-
urine output is reduced
52
Effects on Skin, Temperature, Thirst- shock
changes in skin color, body temp decreases, decreases in metabolism
53
Pleura what kind of membrane covers what 2 layers do what//creates
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
pleura functions provides allows
provides serous fluid allows lungs to move easily over thoracic wall during breathing
55
Bronchioles- air during inspiration during expiration
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
Alveoli exchange of what contains what
gas exchange, contain a surfactant
57
what is surfancant fluid decreases//so
fluid to keep moist decrease surface tension so lungs don’t collapse)
58
Tidal volume
-amount of air moved in and out of lungs with each normal breath
59
Pleural Effusion collection of what where from what
Collection of excess fluid in pleural space, from systemic or local disease (CHF)
60
Empyema Pleural Effusion
-pus in pleural cavity
61
Hemorrhagic Pleural Effusion
-mix blood and pleural fluid
62
what does Large Pleural effusion do and what does it cause
compresses lung tissue (dyspnea
63
Pneumothorax air where ___pressure what's impaired natural recoil causes what
Air in pleural space equalizes pressure, lung expansion impaired natural recoil tendency of the lung causes it to collapse
64
Spontaneous pneumothorax- when what ruptures allows air does what
when air filled bleb (blister) on lung surface ruptures Allows air from airways to enter pleural space Air accumulates until pressures are equalized
65
Primary spontaneous pneumo occurs when cause is
- occurs in previously healthy people, tall slender men ages 16-24, cause unknown
66
Secondary spotaneous pneumo over more usually d/t
over distention and rupture of an alveolus, more serious or life threatening (usually d/t lung condition)
67
s/s of spontaneous pneumo- what pain what at rest what increased chest wall
pleuritic chest pain , sob at rest, RR and HR increased, chest wall movement asymmetrical (less movement on affected side than on unaffected)
68
Placement of a closed-chest catheter allows must be prevents//creating
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
chest tube sealed with what or connected to what
CT sealed with heimlich valve (one-way) or connected to a closed drainage system with water seal
70
water seal prevents what and what else
Water seal prevents air from entering chest cavity during inspiration air to escape during expiration
71
why Low level of suction to system helps what occurs
helps to re-establish negative pressure in pleural space (re-expansion occurs)
72
Chest Tubes placement who does it what is rn responsible for
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
Chest tube Usually placed due to p h f c p c t p
Pneumothorax Hemothorax Flail chest Pulmonary contusion Tension pneumothorax
74
Purpose of Chest Tubes allows drains
Allows for re-expansion of lungs Drains blood or other fluids
75
multiple tubes chest tubes why place in upper/medial why place in lower lobe
Surgery might place a tube in the upper or medial lobe(s) for re-expansion in the lower lobes for drainage
76
rn during insertion c s p
Consent/ Supplies/ Position
77
Rn after procedure of chest tube assess how often have pt do what//nurse do what as well check system why
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
after procedure maintain tape why keep what where dressing
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
rn role with chest tube checking check what assist with what
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
drainage should not exceed how much in 24 hrs
Drainage should not exceed 500 cc in first 24 hours
81
When assisting with removal pt do what nurse do what
Pt to exhale and bear down; place sterile dressing immediately over site
82
what's in first collection chamber this is connected to what which is connected to what
Chest Tube drainage connected to a water seal chamber, connected to the suction control chamber
83
Chamber 1 type of system used for collects
Closed system Used for restoring intrapleural pressure to reinflate lung Collects fluid from the patient
84
Chamber 2 what seal must be prevents/allows
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
chamber 2: should have not what during set up: if not bubbling-
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
Chamber 3 what control set wants different about this and 2
Suction control Set to prescribed setting Same as 2 system setup only with suction being third chamber
87
Is there extreme bubbling in the water chamber check for check what do what
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
Milk tubing when what does
ONLY with MD order. Can increase negative pressure in intrapleural space
89
what does it mean when there is no fluctuating is water seal chamber
something is obstructing tubing check for kinks
90
Dressings and clamps what dressing what in emergency
Sterile Vaseline dressing Padded clamps at bedside for emergency
91
Positioning of tubes and collection device what allows drainange secure system where//does what have what at bedside what prevents dislodgment
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
Assess system how often should remain avoid
Assess every 2-4 hours Should remain patent and intact (sterile) Avoid tension on tube with positioning
93
Respiratory Status every when water seal what should not be present
Q 4 hrs Water seal should fluctuate with respiratory effort Subcutaneous air should NOT be present=palpate around site
94
Drainage-keep when is it removed
Keep tubing free of kinks Removed usually when drainage is less than 50-100ml in 24 hours
95
Bubbling with suction
Can be intermittent or continuous (not excessive
96
If chest tube dislodges do what immediately while pt does what lung call
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
If the drainage system is disconnected from the patient do what to tube place lungs call
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
When is it time to Discontinue a Chest Tube? if for drainage- if for tension pneumo-
, physician will consider removing when drainage is minimal (i.e. a patient with a hemothorax) when the x-ray shows the lung re-inflated

D-Third semester (19 decks)

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