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243 > IV and CVAD from coursepack > Flashcards

IV and CVAD from coursepack Flashcards

1
Q

how often do you flush IVs

A

q8-12hrs

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2
Q

how to flush IV

A

swab w alcohol 15sec 3ml flush syringe-push pause (maybe aspirate) maint pos pressure w thumb on plunger for last0.5ml solution, close clamp, remove

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3
Q

the primary infusion fx

A

for delivery of soln or for maint of vascular volume

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4
Q

continuous infusion (iv soln at constant rate) can also be the ___

A

primary infusion

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5
Q

what is intermittent infusion

A

iv soln admined at prescribed interval iv med may be delivered by pump or gravity drip at the approp rate. when the IV med is finished the tubing is disconnected and the IV access device is flushed

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6
Q

IV piggyback is aka

A

aka secondary infusion IV soln or med attached to main set thats started concurrently or intermittently with the primary infusion

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7
Q

IV bolus

A

Conc med or soln given over short time either IV direct or thru infusion set. Lookup monograph for specified timeframe over which to give soln

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8
Q

IV direct

A

Admin of Ned via syringe over specific period of time >1min

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9
Q

How to choose where to give IV direct message on tubing

A

If IV monograph says “direct into IV tubing” can give via syringe into lowest portfolio infusing IV or directly into cap of extension set. Decide via fluid status, potential for adverse run and risk of phlebitis.

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10
Q

What can happen if give IV med too quick

A

Can result in death or other

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11
Q

What is IV push

A

Rapid admin of bolus of Med via syringe

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12
Q

When would IV push med be necessary

A

When rapid response is needed eg cpr

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13
Q

What is kvo

A

Keeping vein open for future requirements of infusion May mean adding extension sets, caps or continuous infusion at low rate

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14
Q

What must a kvo rate have

A

A drs order w specific rate

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15
Q

What does checking for blood return confirm

A

If there’s blood return it shows patency but doesn’t confirm tip position. if theres no return it shows catheter malfunction & warrants assessment

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16
Q

Are piccs and peripheral ivs both vads

A

Yes

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17
Q

What do if can’t flush or aspirate peripheral IV

A

Remove

18
Q
  • if a peripheral IV has some resistance when flushing what do
  • what do if kinked
  • what do if blood in tubing
A
  • assess tubing for kinks etc
  • check under drsg
  • is catheter kinked at site? if yes and you can flush then apply drsg
  • if theres no kink or blood at site then remove
19
Q

what size NaCl to use to flush CVAD

A

10ml minimum

20
Q
A
21
Q

when to change drsg after initial CVAD insertion

A

24h after insertion

22
Q

how often to assess CVC

A

qshift

before access

after access

23
Q

what to document/assess for CVC

A
  • site for redness, swelling, drainage
  • connections secure
  • drsg dry
  • sutures intact
  • measure external segment….
    • clamp unused lumens CHANGE POSITION OF CLAMPS DAILY TO PREVENT DAMAGE TO LUMEN
24
Q

if external segment of CVC moves more than __cm in adult or ___cm in kids what must be done

A
  • >5cm in adult or >1cm in kid notify dr.
  • xray must be done to confirm position
25
Q

transparent dressing change VIHA procedure

  • how often to change?
A
  • drsg and cap 7 days and PRN
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26
Q

how often to change gauze drsg CVC

A

q2 days and PRN

27
Q

CVC tubing change timing

A
  • q96hrs if continuous infusion
    • q24hrs if intermittent use or TPN
28
Q

how to flush CVC

A
  • aspirate for blood before use to confirm patency
  • use 10ml NS pre and post medications
    • lock catheter w 3ml heparin lock soln
29
Q

what is nec for removal VIHA

A

dr order

apply occlusive drsg (vaseline impregnated gauze, then gauze and transparent drsg to remain in place x24hr

30
Q

why use vaseline impregnated gauze after removal

A

to prevent air embolism and dec risk of infection

31
Q

what is ASASH

A
  • aspirate
  • saline
  • admin med
  • saline
  • heparin
32
Q

if you have a capped lumen not in use how often to flush

A

q24h w ASASH

33
Q

what are the various coloured lumens for generally

A
  • brown is distal (at tip of catheter)-
    • TPN, blood, CVP monitoring
  • blue is medial and exits 1’above distal site-
    • TPN, meds, general access, blood
  • proximal-
    • meds, general access
34
Q

how many saline syringes to bring if pt has 3 lumens

A
  1. 3 for each. you should only use 2 for each lumen but if you aspirate blood into one you have to toss it….actually probably 12 because the procedure says to do 2 initial flushes one after another
35
Q

flush technique in general

A

turbulent flush (this is forceful)

36
Q

flush CVC procedure for in use line

A
  • CLEANSE 30sec. let dry
  • aspirate. discard if gets into syringe
  • fush w 10ml NS. CLAMP AND REMOVE.
  • flush w 10ml NS. Clamp.
  • CLEANSE
  • med
  • CLEANSE
  • heparin and end w positive pressure
  • clamp
37
Q

how to flush capped lumen not in use

A
38
Q

solution bag change

A
  • label admin set w date to be changed and apply below chamber
  • attach bag to tubing and purge tubing of air
  • label w pt name, date, flow rate, nurse initials, and time
  • place sterile cap on end of tubing
  • assess site
  • stop infusions and close clamp
  • put on gloves
  • MAKE SURE CLAMP IS CLOSED ON LUMEN TO BE CHANGED
  • cleanse tubing, connection
  • d/c admin set and attach new primed set
  • open clamp. re establish infusion
39
Q

what to label soln for CVAD with

A

label w pt name, date, flow rate, nurse initials, and time

40
Q

s/s of catheter migration

A
  • catheter measurement of +/-5cm from insertion record
  • pt hears gurgling sound in ear on catheter insertion side
  • pain in chest, shoulder, back
  • catheter occlusion (indicated by lack of blood return, resistance during injection, alterations in gravity flow rate. may be partial or complete occlusion)
41
Q

first instructions to pt w no blood return from CVC

what if theres still no blood return but you can flush

A
  • take deep breath and cough
  • raise and lower arms
  • change position
  • ask pt to repeat above
  • if still no blood return
  • flush w 20ml NS
  • get drs order
42
Q

youve already flushed w 30ml and theres still no blood return what will happen with the drs order

A

drs order

  • admin de-clotting agent as per protocol
  • may need to repeat
  • may need to confirm placement
  • if none of this indicates patency then dr will want to remove

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