IV and CVAD from coursepack Flashcards
how often do you flush IVs
q8-12hrs
how to flush IV
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
the primary infusion fx
for delivery of soln or for maint of vascular volume
continuous infusion (iv soln at constant rate) can also be the ___
primary infusion
what is intermittent infusion
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
IV piggyback is aka
aka secondary infusion IV soln or med attached to main set thats started concurrently or intermittently with the primary infusion
IV bolus
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
IV direct
Admin of Ned via syringe over specific period of time >1min
How to choose where to give IV direct message on tubing
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.
What can happen if give IV med too quick
Can result in death or other
What is IV push
Rapid admin of bolus of Med via syringe
When would IV push med be necessary
When rapid response is needed eg cpr
What is kvo
Keeping vein open for future requirements of infusion May mean adding extension sets, caps or continuous infusion at low rate
What must a kvo rate have
A drs order w specific rate
What does checking for blood return confirm
If there’s blood return it shows patency but doesn’t confirm tip position. if theres no return it shows catheter malfunction & warrants assessment
Are piccs and peripheral ivs both vads
Yes
What do if can’t flush or aspirate peripheral IV
Remove
- if a peripheral IV has some resistance when flushing what do
- what do if kinked
- what do if blood in tubing
- 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
what size NaCl to use to flush CVAD
10ml minimum
when to change drsg after initial CVAD insertion
24h after insertion
how often to assess CVC
qshift
before access
after access
what to document/assess for CVC
- 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
if external segment of CVC moves more than __cm in adult or ___cm in kids what must be done
- >5cm in adult or >1cm in kid notify dr.
- xray must be done to confirm position
transparent dressing change VIHA procedure
- how often to change?
- drsg and cap 7 days and PRN
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how often to change gauze drsg CVC
q2 days and PRN
CVC tubing change timing
- q96hrs if continuous infusion
- q24hrs if intermittent use or TPN
how to flush CVC
- aspirate for blood before use to confirm patency
- use 10ml NS pre and post medications
- lock catheter w 3ml heparin lock soln
what is nec for removal VIHA
dr order
apply occlusive drsg (vaseline impregnated gauze, then gauze and transparent drsg to remain in place x24hr
why use vaseline impregnated gauze after removal
to prevent air embolism and dec risk of infection
what is ASASH
- aspirate
- saline
- admin med
- saline
- heparin
if you have a capped lumen not in use how often to flush
q24h w ASASH
what are the various coloured lumens for generally
- 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
how many saline syringes to bring if pt has 3 lumens
- 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
flush technique in general
turbulent flush (this is forceful)
flush CVC procedure for in use line
- 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
how to flush capped lumen not in use
solution bag change
- 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
what to label soln for CVAD with
label w pt name, date, flow rate, nurse initials, and time
s/s of catheter migration
- 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)
first instructions to pt w no blood return from CVC
what if theres still no blood return but you can flush
- 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
youve already flushed w 30ml and theres still no blood return what will happen with the drs order
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
