Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

243 > Fraser health CVAD > Flashcards

Fraser health CVAD Flashcards

1
Q

what is the specific name of the area which a central line sits

A

The tip of the CVC usually rests in the Cavo-Atrial Junction (CAJ). This junction marks
the inferior end of the superior vena cava (SVC), the continuation below that point being
considered part of the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

indications for CVCs

A

-Administer intravenous fluids and blood products
♦ Administer hypertonic solutions (Total Parental Nutrition [TPN]), vesicants
(i.e.chemotherapy), irritants (i.e.cloxacillin), and solutions with extreme pH values
(i.e.vancomycin).
♦ Obtain venous blood samples
♦ Provide long term intravenous therapy
♦ Administer large volumes of intravenous fluid quickly
♦ Administer vasopressor or vasodilator therapy (e.g. Dopamine)
♦ Monitor central venous pressure (CVP)
♦ Provide access for transvenous pacemaker or pulmonary artery catheters
♦ Access venous circulation when a patient has difficult or impossible peripheral access
♦ Provide hemodialysis access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which veins can central lines be inserted through from the various approaches

A

The Neck/Upper Chest
>Internal jugular vein
>External jugular vein
>Subclavian vein

The Arm
> Brachial vein
> Cephalic vein
> Basilic vein

The Groin
> Femoral vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which types of central lines MAY have closed ended catheters

A

May be present on Tunneled Catheters, Implanted Ports and PICCs
-however, any typeof CVC can be open ended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the diff between closed and open ended catheters

A
  • closed ended may have clamps at distal or proximal ends. These clamps only open when infusing or aspirating
  • open ended requires clamping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where is a groshong valve

A

A valve is present at the tip of the catheter (eg. Groshong®)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

do open ended clamps reuire clamping

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

1) Which of the following would not be considered a CVC? A catheter placed:
a) in the radial artery
b) in the superior vena cava
c) so its tip is at the junction between the superior vena cava and the radial artery
d) with its tip in the external jugular vein

A

so its tip is at the junction bet the superior vena cava and the radial artery (not CVC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

short term open ended catheters

uses

A 
Short term use,
but may be left in
as long as the
catheter is needed,
if it is still
functional and not
a source of
infection
♦ Emergency access
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

short term open ended catheters advantages

A 
All types of therapies can be administered
• Preserves peripheral veins
• Can be single, double, or triple lumen
• Adult or pediatric sizes
• Can be used for blood sampling
• Economic, quick placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

examples of ST catheters

A 
-single lumen short-term CVC
♦ Multi-lumen short-term CVC
♦ Percutaneous introducer
♦ Femoral CVC
♦ Temporary hemodialysis catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

short term open ended disadvantage

A 
HIGHEST risk for infection
•
Not for home intravenous therapy
•
Greater risk of insertion and post insertion complications (i.e.: pneumothorax, air embolism)
•
Not to be used long term. Consider referral for insertion of long-term CVC if it will be needed for >14 days
•
Firm catheter may erode the vessel
•
Can be easily dislodged
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

no cards on hemodialysis catheters

A

w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when inserting CVC what type of protection is worn

A

The patient is covered from head to toe with a sterile drape with a small opening for the insertion site (to observe/monitor the patient’s head area, consider placing a mayo stand under the drape in this area).
o
The inserting practitioner must remove jewellery, wear eye protection, hand wash to remove visible dirt (soap and water or 2% Chlorhexidine), subsequent hand washing before and after palpating catheter insertion site (alcohol gel is sufficient), and use a surgical cap (bouffant cap), mask, sterile gown, and sterile gloves.
o
The assisting practitioner must hand wash and use a surgical cap (bouffant cap), mask, sterile gown, and sterile gloves.
o
Other personnel, such as those without direct contact, must wear a mask

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

is CXR necessary when using femoral site

A

FEMORAL SITE: If a Short-term CVC is inserted into a femoral site – no chest x-ray required. To confirm correct placement in vein, draw blood gas from the femoral CVC and send sample to Lab to ensure the results are a venous sample (Venous Blood Gases). In Critical Care areas, transduce the femoral CVC and ensure you have an appropriate CVP waveform.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

post insertion care after xray

A

Ensure that all lumens are flushed with 20 mL of NS immediately after insertion.
o
Monitor patient vital signs every 30 min x 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Short-term catheters have the ___________ rate of infection.

A

highest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Short-term catheters are ________ ended.

A

open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

post insertion check for signs of

A 
a)
Subcutaneous emphysema
b)
Bleeding
c)
Air embolus
d)
Pneumothorax
20
Q

who is a PICC suited for

A

PICCs are chosen for patients requiring IV therapy for more than six days and up to one year.

21
Q

where is a PICC inserted

A

Venous access is obtained by puncturing the brachial, cephalic, or basilic vein just above or below the antecubital fossa.

22
Q

when are PICC lines used

A

Intended for days to several weeks to months of IV access
•
Peripheral insertion may be needed for patients with chest injuries, radical neck dissection or radiation therapy to chest.

23
Q

PICC line advantages

A 
PICCs are inserted by Advanced Competency Assessed RNs (i.e. Home IV team)
•
Can remain in place
for several weeks to a year
•
Easily removed by a Competency Assessed RN
•
PICCs eliminate the risks associated with neck, chest & femoral insertion
•
Low infection rate
•
External portion can be repaired
24
Q

PICC line disadvantages

A 
Requires a dressing & frequent assessments
•
External device
•
Some PICCs (small gauge) not
recommended for blood sampling
•
Not ideal for rapid infusions
•
Not recommended route for some medications (i.e.phenytoin). Check Parenteral Drug Therapy Manual prior to use

-difficult for self care

25
Q

considerations for sx insertion of PICC

A

may need sedativ

26
Q

BP with a PICC

A

dont use the arm with PICC in it

27
Q

intervention to prevent mechanical phlebitis for PICC

how often to assess rate of infusion and site patency

A

apply warm compress to arm ABOVE PICC venipuncture site QIDx 20min for 3 days PRN

assess q1h

28
Q

what is a tunneled catheter

A

A tunneled catheter is a long-term catheter (lasting months to years) that exits the skin via a subcutaneous tunnel.
♦
A Dacron cuff on the tunneled portion of the catheter facilitates anchoring of the catheter through granulation and acts as a barrier to infection.

29
Q

how many lumens do tunnled catheters have

examples of names

A

Tunneled catheters may be single, double, or triple lumen.
♦
Examples of Tunneled Catheters are Hickmans®, Broviac® and permanent hemodialysis catheters (eg. Perm-Cath®).

30
Q

how are tunneled catheter inserted

what is the nurses role

A

Tunneled catheters may be inserted in the Operating Room under a local anaesthetic or in Radiology under fluoroscopy.
The Nurse’s role in the insertion of a tunneled catheter involves pre-insertion teaching, assessment, and post-operative site care.

31
Q

tunneled catheter uses

A

Used for long-term intermittent or continuous access for:
•
Medication administration (including vesicants)
•
Parenteral nutrition
•
Blood/blood product administration and sampling
•
Hemodialysis

32
Q

tunneled catheter advanatage

A

Can be left in place indefinitely (if no infection, blockage or thrombosis)
•
External portion can be repaired
•
Self-care by patient
•
Once site healed, no dressing is needed at home

33
Q

tunneled cath disadvantages

A 
Inserted in the OR or Medical Imaging under Fluoroscopy
•
Requires a dressing & frequent assessments
•
External device
•
Physician must
remove
34
Q

what is different about securement of catheter PICC vs tunneledd

A

tunneled generally have cuffs (and often two) which are part of the catheter and sit above the skin site. they help secure the catheter

35
Q

post insertion care of tunneled catheter, IVAD

A 
♦
Post-Insertion and q30 minutes x 2:
􀂾
Vital signs: BP, HR and RR
􀂾
Respiratory assessment including: breathing patterns, depth, symmetry and breath sounds
􀂾
Check for signs of:
o
Subcutaneous emphysema
o
Bleeding
o
Air embolus
o
Pneumothorax
􀂾
36
Q

how many drsgs will the tunneled catheter pt have

A

one for entry site and one for exit site

37
Q

how to deaccess an implantable venous access device

A

When de-accessing an IVAD, a 5 mL of heparin 10 units/mL (dose to be administered 50 units) pre-filled syringe is used

38
Q

where can IVADs be placed

A

thoracic and peripheral eg in the arm

39
Q

IVAD

A

Used for long-term intermittent or continuous access for:
•
Medication administration (including vesicants)
•
Parenteral nutrition
•
Blood/blood product administration and sampling

40
Q

IVAD advantages

A 
Internal device, no dressing or site care
•
Can be permanent
•
Unrestricted activity
•
Decreased risk of infection
•
No external components to break
•
Less body image impact
•
May be used as long as the device is required, functional, and is not a source of sepsis.
41
Q

IVAD disadantages

A

Needle access is required
•
Surgical procedure required to insert/remove

42
Q

consideration about sending woman to sx for IVAD insertion

A

􀀾

Female patients are sent with their bras to the OR/Medical Imaging to aid the surgeon with site selection.

43
Q

how to access CVAD

A

Once healed if accessed, a transparent dressing is applied to the site and then the IVAD is treated as any other CVC. When not accessed, no dressing is required.

44
Q

what is twiddlers sydrome and what to do if it occurs

A

“Twiddler’s Syndrome” occurs when a port is dislodged within the subcutaneous pocket because of trauma to the site or manipulation (twiddling) of the port by the patient. When this occurs, the port is noted to move easily under the skin. Resistance may also be noted when attempting to infuse and swelling may occur at the site. If this occurs, stop using the port and notify the Physician to re-stabilize or re-insert the port

45
Q

name of the needle used to access the IVAD

A

non coring (safestep is brand name)

46
Q

postinsertion care for CVAD is completed how often

A

q30min x2

243 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions