E2. L3. - Parenteral Vascular Access Devices Flashcards by Jenna Tapper

Vascular access devices two classes

peripheral
central

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Peripheral vascular access devices

Needle
Over-the-needle-catheter

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Central vascular access devices

Peripherally-inserted central catheter (PICC)
Surgically implanted
-cannot just place in and pull out, must stay

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Peripheral catheter: IV

IV catheter - vein on the limbs
-drip chamber
Y-site - piggyback
clamp - control flow rate
Now - use more and more pumps
-In emergency, may not have time to set up pump

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Different Peripheral access devices

Metered burette
Partial-fill container
Partial fill premix
ADD-vantage
CRIS (only one not available today)
Drug manufacturer’s piggyback/Faspak
Vented syringe infusion
Syringe pump infusion

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Basic set

One y site
Piercing spike, drop orifice, drip chamber, luer-lock adapter, roller clamp one y site

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Add a line set

Two y sites
Some drugs do not like to mix w/anything = second y site while first one is being flushed to use later on again
Sometimes used to give quickly w/o coming into contact w/each other

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Peripheral access: administration sets

Looks VERY similar to IV bag
Difference? - container that has marks for measurements
Need something that is a little more accurate - volume control set
Also can be used on patients who have restrictions

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Peripheral access: ADD-Vantage

Media fill: USP At least once a year
Take liquid from a vial - transfer them
ADD vantage:
Vial (rubber seal, sterile inside)
Rubber bag also has rubber seal
remove stoppers and connect -> mixes with the liquid but does not matter because sterile and mixed in aseptic conditions (done in 30 seconds, risk of contamination is minimal)

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Why don’t we use ADD-Vantage more often?

EXPENSIVE
Generic is much cheaper, have to go through ampule to vial, vial to bag
-Different ways of dosing
-Being tested for the most traditional

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Macro vs micro drip

Macro: Larger quantities at faster rates
10, 15, or 20gtt/mL
Macro is the standard
Micro
Smaller amounts
~60 gtt/mL
Used in pediatrics or patients who need small or closely regulated amounts of IV solution

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Drop conversion factor/drop number

For water, external degrees
Informed guess - will not be exactly 15, but good estimate
Drip chamber is NOT a corrective thing
Pumps are very smart machines now - programmed to say what dose to give HOWEVER they just push, do not know if it is going into the patient

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Poiseullies Law

rate = driving force/resistance

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Poiseuilles law verbal

Liquid law for whenever you are putting liquid into a patient
Numerator and denominator:
Driving force - push the liquid in
resistance
Entropy is pressure
N - viscosity
L - length of tubing
Know forces that are pulling one way or the other**

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Components of resistance to flow: tubing

Macrobe vis microbe (thin diameter makes it harder to go through)
In line filter (may or may not be used)
Viscosity of IV fluid
Length of tubing venous backpressure
-Position of patient will make a difference on pressure
-Want to change flow rate? - move patient position

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Volume fill

Take out of container to admix it
-Has impact
Container will tell you how much it contains
-Does not contain exact amount - some excess
0.5mL container - person who does compounding is able to pull out that volume (excess stays on corners)
-If liquid happens to be more viscous - we will have more excess
-more likely to stick to sides - does not want to come out
Smaller the volume - larger the difference will be
-Proportion of % of excess

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Drop conversion factor - drop number

The drop conversion factor is an initial educated guess
It is seldom the exact conversion factor for actual parenteral preps
Actual number of drops/mL depends on:
-Viscosity of the CSP
-Surface tension
-Density

Peripheral access “butterfly” needle

Little wings
if patient moves hand - stays with motion of hand
wings fix it in place

Over-the-needle catheter

Longer
Metal part is used to pierce the vein
Plastic used to pull the needle
Flexible - does not hurt as much, risk of cutting/scratching vein is reduced

Central venous therapy

Lots of volume, lots of blood flow, large volume of fluid
Multiple infusions
Long-term infusion therapy
Infusion of irritating medications like potassium
Infusion of fluids of high osmolarity
-may not necessarily be lethal to cells
But not the norm - do not want it to be shrunk for a long time (shrink quickly, come back)
-Parenteral nutrition (PN)

Central lines - PICC

Peripherally inserted central catheter
Put through arm - goes all the way to the door of the heart

PICC line - easy or complex

COMPLEX PROCESS

Central venous access - functionality

Can go through uvular if needed (if patient has something blocking arm)

Central vein catheter - surgical implant

Multiple lumens - can give three different medications and they do not come into contact w/each other

Central lines common names

Hickman and Broviac Like coke and pepsi of catheters -PICC line is Dr. Pepper Same function, designed by different doctors

Hickman catheter

Requires surgical insertion Dacron cuff prevents excess motion -Instead of going through arm, surgically inserted -Starts in chest -Put a little plug in there -Prevents things from coming in: little complications w/infection -Even if patient moves - affixed to the site of insertion

Central lines - vascular access port

Surgically implanted under the skin -No exposure -Aseptic -Make sure it does not get destroyed - if destroyed, have to pull out and do again

Central lines - Vascular Access Port (VAP)

Non-coring needle -Bent -Cut rubber, but rubber can seal back after that

Advantages of Central Venous Therapy

Access to central veins Rapid infusion of large amounts of fluid A way to draw blood and measure CV pressure Reduced need for repeated venipunctures Reduced risk of vein irritation from infusing irritating substances

Risk of Central Venous Therapy

Sepsis Thrombus formation Perforation of vessel and adjacent organs Air embolism (LARGE volume = LARGE bubble - very problematic) Can accidentally pierce wrong vein Disadvantages: Cost Requires more skill to insert than peripheral therapy

Risk associated w/infusion:

Complications from damage to the inner lining of the vein (intima): Stenosis (narrowing) Thrombus (clot) Venous occlusion Chemical inflammation (phlebitis) and pain

Instrumented flow control: controllers vs pumps

Controllers - rarely used anymore (use gravity as driving force) Pumps - used all the time: powered devices

Instrumented flow: Control

Controls the speed, gravity based Bag HAS TO BE above pump -Technically pump could do without having bag above, but it would be harder

Infusion pumps

Powered devices Pumps provide pressures in the range of 2-12 psi (100-600mmHg)**LARGE**. the high end of this pressure range is used for arterial infusions Caution: the use of excessive infusion pressures can be a hazard w/respect to infiltration at the site of injection A pump is a brute machine - if something is not working **it will still keep pushing**

Features of infusion pumps

Volumetric delivery, independent of vascular back-pressure, position of patient, composition of infusion solution, or tubing resistance Position of patient - back pressure

Features of infusion pumps - safety (alarms)

Occlusion of line Infusion complete Air in line Empty container Flow rate error -Becoming increasingly smart

T/F: use of infusion pumps turns the drip chamber into ornamental item

False - drip chamber is a window into what is happening

Syringe Pumps

Use commercial syringes Smart machines Especially useful for giving intermittent IV meds Provide the best control for small volume infusions Useful for **pediatric patients** **Know from brand name and volume what rate to move**

Patient controlled analgesia (PCA)

Pain relief is generally obtained at a lower total dose of drug -Press a button, release drug -Potential for abuse

Ambulatory pumps

refers to size and weight of the pump, as well as ability to operate w/o an external power sourceI

Implantable pumps

Usually with reservoirs of ~50mL. Used for IV, intraspinal, and intra-arterial routes. Can deliver as low as 1 microliter/hour

When to use ambulatory vs implantable

How long it will be in patient Do the same thing, one is just long term