Final Flashcards
PICC
Peripherally inserted central catheter
CVAD
Central venous access devices
PIVC
Peripheral intravenous catheter
CLASBI
Local or systemic
Local: around insertion site
Systemic: bloodstream
Central Line “Bundle”
Individual skills grouped together
Hand hygiene prior to catheter insertion
Maximal sterile barrier precautions with insertion (inserter wears a cap, mask, sterile gloves and gown, and a large sterile drape is placed over patient during insertion)
Chlorhexidine skin antisepsis
Optimal catheter site selection, with avoidance of the femoral vein for central venous access in adult patients
Daily review of the line necessity with prompt removal of unnecessary lines
Central Line Complication Prevention
Pneumothorax
Air embolus
Cardiac Tamponade – Beck’s triad
Pleural Effusion (Hydrothorax, Hemothorax)
Nerve Injury, skin breakdown
Catheter occlusion – how do we know?
Infiltration – how are the s/d different than PIVC infiltration?
Arterial puncture
Phlebitis
Venous thrombosis
Catheter Malposition- what are s/s it is not where it should be?
Central Line Complications
occurs when bacteria or other germs enter the patient’s central line and then enter into their bloodstream. These infections are serious but can often be successfully treated.
Can be local or systemic.
Central line bloodstream infection (CLABSI)
due to inadvertent puncture of the lung at the time of inserting a needle into a large vein
The needle in the CVC placed in the neck or chest can go through the vein or miss the vein and could pierce the lung, causing the lung to collapse.
Pneumothorax
occurs when air or gas is admitted into the vascular system
Air embolus
a collection of three medical signs associated with acute cardiac tamponade, a medical emergency when excessive fluid accumulates in the pericardial sac around the heart and impairs its ability to pump blood. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.
Cardiac Tamponade – Beck’s triad
Various kinds of fluid can accumulate in the pleural space, such as serous fluid (hydrothorax), blood (hemothorax), pus (pyothorax, more commonly known as pleural empyema), chyle (chylothorax), or very rarely urine (urinothorax).
Pleural Effusion (Hydrothorax, Hemothorax)
the most common noninfectious complication associated with long-term venous access.
Symptoms of a catheter-related venous thrombosis may consist of neck vein distension, edema, tingling, or pain over the ipsilateral arm and neck, and a prominent venous pattern over the anterior chest.
Catheter occlusion – how do we know?
the leakage of intravenous (IV) fluids or medications into surrounding areas.
Infiltration – how are the s/d different than PIVC infiltration?
when a needle is inserted into an artery rather than a vein.
Arterial puncture
Inflammation of a vein
Phlebitis
a condition that occurs when a blood clot forms in a vein
Venous thrombosis
The most common complications of misplacement or malposition include thrombophlebitis, infection and bleeding.
Catheter Malposition- what are s/s it is not where it should be?
Infiltration
Extravasation
Phlebitis
Thrombosis
Infection
Ecchymosis
Hematoma
Peripheral IV Complications
Fluid leaking into tissues
Can cause tissue damage
Cause
Catheter dislodgement
Poking distal to a previous attempt
Symptoms
Pain
Swelling
Coolness
Pallor
Loose/wet dressing
Pump alarms/low volume in IV bag
Interventions/Prevention
Don’t start IV in area of flexion
Regular assessment
Explanation to the patient to report discomfort/unusual sensations
Educating pt about what to expect can help identify infiltration early
Stop infusion immediately
Infiltration
Leakage of solution/medication into surrounding tissue
Pharmacological properties of infusate determine level of irritation
“Vesicants”
Hyperosmolar, non-neutral pH, general irritant/cell unfriendly
Symptoms
Pain, edema, stinging/burning, warmth, redness, blisters
Interventions/Prevention
Regular assessment
Extraversion
Most common complication
Inflammation of a vein
Types
Mechanical: catheter against the vein
Chemical: Solution/medication
Bacterial: contamination from insertion/management
Dehydration a risk factor (increased blood viscosity)
Interventions/Prevention
Warm, moist heat
Elevate
Change site
Phlebitis
Inflammation of vein
Symptoms
Redness, inflammation, tenderness, pain
Warmth to the area
Limb Pain
Hardening of vein (“ropelike”, “cordlike”)
Interventions/Prevention
Regular assessment
Changing site regularly per policy and if symptoms appear
Phlebitis/Thrombophlebitis
Symptoms
Local: Pain, redness, swelling, drainage
Systemic: Fever, sweating
Interventions/Prevention
Regular assessment
Asepsis during insertion, dressing changes, whenever accessing the line/port
Asepsis when preparing bags to hang
Educate pt to report pain
All previous tips from INS to reduce infection
Infection
Internal bleed at site (under the skin)
Pictured: Ecchymosis
Hematoma is hard, painful lump
Causes
Nicking the vein (unsuccessful insertion)
If needle “blows the vein” and pressure is not applied
Incomplete insertion
Lack of pressure over d/c site
Large cannula
Symptoms
Swelling, pain, large bruise
Interventions/Prevention
Regular assessment
Assess patient labs – coagulation
Are they on blood thinners?
Applying pressure when removing needle after failed attempt
Elevate extremity until bleeding stops after unsuccessful attempt
Ecchymosis/Hematoma
Nursing considerations for __________:
Comprehensive assessment
Informed consent
Evidence-based education and skill development
Evaluation of the need and appropriateness of a VAD
Management of PIVC: careful monitoring of the site, patency, and dressing
Documentation
Peripheral IV – varies by region/employer – generally for shorter term treatment (days)
peripheral vascular access devices
