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N243 > Midterm #1 - CVADs & IV Meds > Flashcards

Midterm #1 - CVADs & IV Meds Flashcards

1
Q

CVAD Assessments

A 
Site
Dressing
Length of external segment
Plus:
Check site and care plan at start of shift & prn
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2
Q

CVAD cap change

A

Q7days or prn

Change one change all

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3
Q

Unused lumen flushes

  • PICC
  • CVC
A

PICC- q7days

CVC- qShift due to more prone to infection

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4
Q

Initial use of CVAD, placement confirmation

A

US for insertion
ECG P wave amplitude change
X ray to confirm placement

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5
Q

CVAD flushing procedure

A
  • Flush with minimun of 10mL of NS - turbulent fushing
  • Ensure to swab cap between each syringe attachment
  • Maintain positive pressure, do not bottom out the syringe

PICC- inject 1-2mL of NS to open valve. Then aspirate for blood return.
CVC- Disengage clamp. Aspirate for blood return.

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6
Q

Blood Sampling

A

Blood specimen collection for blood sampling may be taken…
- Peripheral venous access devices ONLY at the time of insertion~
- CVADs when…
Peripheral access is difficult or unobtainable
More than 2 samples per day are required
PT experiences high level of anxiety or discomfort

DO NOT draw from CVAD lumen used to

  • TPN, dextran, or cyclosporine
  • administer the drug for which levels are being drawn to test - eg antibiotics - it is not accurate
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7
Q

Why peripheral samples are preferred for blood samples than CVADs

A

Blood sample may be affected by the medication or solution being infused

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8
Q

What time should a solution be stopped prior to blood sample

A

5 minutes and flush after with 10mL of NS

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9
Q

How many mL of blood should be discarded for blood sampling

  • adult
  • ped
A

Adult 5mL
Ped 3mL
Neonates follow guidelines

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10
Q

____mL of NS flushing after blood draw

A

20mL and flush other lumens with 10mL

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11
Q

PICC insertion sites

A

Above the antecubital fossa

  • basilic vein
  • cephalic vein
  • brachial vein
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12
Q

PICC post insertion assessments

A

VS - BP, HR, RR and PRN
Monitor for signs of pneumothorax -auscultate chest prn
Compare insertion site with opposite side for signs of
- swelling, hardness, redness, coolness and discomfort every shift

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13
Q

What is a CVAD

A

Indwelling catheter inserted into a vein of the central vascular system

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14
Q

Why are CVADs used

A
  • Admin IV fluids and blood products
  • Admin meds and multiple incompatible meds simultaneously
  • Admin hypertonic solutions -TPN, vesicants - chemo, irritants and solutions with extreme pH values
  • Obtain venous blood samples
  • Long-term IV therapy
  • Access venous circulation when a PT has difficult or impossible peripheral access
  • Monitor central venous pressure in ill PTs
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15
Q

Types of Central Venous Access Devices

A

1- Short-term devices - CVC
2- Externally tunneled - Hickman, CVC
3- Peripherally Inserted Central Catheter
4- Implanted Venous Ports - Port-a-cath

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16
Q

CVC

A
  • Inserted through the subclavian vein, jugular vein, or femoral vein
  • Used for short-term therapy - days to several weeks
  • Single, double or triple lumen
  • Clamps - non-valved
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17
Q

PICC

A
  • days to months
  • single, double or triple lumen
  • valved - Groshong valve that negates the need for heparin locks
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18
Q

CVADs similarities

A
  • All require assessment: pre, during & post
  • Dressing and cap change
  • Flushing
19
Q

CVADs differences

A
  • Short versus long-term
  • Tunneled versus non-tunneled
  • Open versus closed ended
  • Valved versus non valved
  • Insertion and tip location
20
Q

Patient teaching

A
  • Assess PT knowledge
  • Age and cognitive status considerations
  • Inform PT to report any discomfort at the site neck or SOB
21
Q

CVAD disadvantages

A
  • PT has a level of responsability for caring for the catheter
  • Activity restrictions, limits in repetitive arm movement, no swiming
  • Mechanical phlebitis
  • Risk of thrombus in small vessels
  • Risk of occlusion
  • Migration of catheter
22
Q

Measurement of external segment - migration
Adult
Peds

A

Adults greater than 5cm
Peds greater than 1cm
X-Ray is required for placement check

23
Q

Occlusion Types

A
  • Mechanical occlusions - kinks, tip migration or blocked, blocked needless connectors
  • Chemical occlusion r/t med or drug precipitate
  • Thrombotic occlusion r/t formation of thrombus within or around CVAD

If unable to return patency notify physician, xray or dye study may be required

24
Q

Types of catheter occlusion

A

Need to be treated asap

  • Partial occlusion - sluggish flush and flow, resistance w/ flushing
  • Withdrawal occlusion - inability to aspirate blood
  • Complete occlusion - inability to infuse fluids or aspirate
25
Infection
Prevention is always a priority! Catheter site is a portal of entry Catheter related bloodstream infections - microorganisms grow in the central line and spread to the bloodstream Infection worsen underlying health problems 85% of bacteria found on the skin are responsible for CRBSI!!
26
PT related risk factors for infection
- Immuno suppressed - Neutropenia - Poor nutrition - Renal failure - Chronic Infection - Diabetes - Short bowel syndrome - Self-care deficit: poor hygiene and ability to manage care
27
Phlebitis
Inflammation of one or all three layers of the vein wall Types: 1 Mechanical 2 Chemical 3 Bacterial
28
Venous Thrombosis
Normal physiological response to a foreign body, such as a CVAD. Caused by aggregation of platelets and accumulation of fibrin
29
S+S of Venous Thrombosis
-Edema of the hand, arm, shoulder neck on the side of the catheter placement -Distended jugular veins -Appearance of dilated collateral vein over the chest, upper arm -Dyspnea -Discoloration of the skin - cyanosis Complications - Superior Vena Cava - Facial flushing and swelling, neck pain or swelling, headaches or a sensation
30
Catheter migration causes
- vomiting, coughing, sneezing, heavy lifting, changes in thoracic pressure - Heart failure - Tumors - Mechanical ventilation - Securement dressing is not intact or become wet and loose
31
S+S of catheter migration
- external segment of changes, greater 5cm more than original external measurement - leaking of fluid at the insertion site - swelling, pain, redness in chest or at insertion site - inability to flush or aspirate catheter - arrhthmias - visible assessment shows coiling of catheter under the skin
32
Air embolus
- Caused by entry of air into vascular system - Creating an intra cardiac air lock at the pulmonic valve this prevents the ejection of blood from the right side of the heart
33
S+S Air Embolus
- Hypoxia, rapid onset of SOB, coughing , anxiety - Hypotension - Cyanosis - Palpitations or arrhythmias, weak rapid pulse - Chest and shoulder pain - Loss of consciousness
34
IV Meds Admin Types
- Intermittent infusion - IV direct/push - IV Bolus - Continuous Drip Infusion into the main primary IV bag
35
Compatibility IV Meds
Drug to Diluent Drug to Primary Solution Drug to Drug
36
IV Meds advantages
Unconscious PT med admin Quick therapeutic effect of med Control of how much to give, stop or hold Constant absorption
37
IV Meds disadvantages
- Rapid severe reaction to med - Fluid overload - IV site complications: speed shock-drug builds up becomes toxic, anaphylaxis,...
38
Anaphylaxis s+s
``` Swelling Angioedema Nause Confusion Stridor Hypotension Tachycardia ```
39
Anaphylaxis Prevention
- Allergy screening - Antidote - Teaching - Diligent checking
40
Anaphylaxis Intervention
- Remove the antigen STOP INFUSION - Stay with PT - Call for help CALL A CODE - Apply O2 - Vitals, SpO2, assess ABC - KVO/ start IV - Emotional support
41
IV Drug Monograph
It contains: - Indications/Contraindications - Cautions and monitoring PT - Admin who may give and how - Reconstitution, dilution, compatibility & incompatibility - Recomended rates of admin - Adverse effects
42
Intermittent Infusion
An infusion of a volume of fluid/med over a set period of time, then is stopped until the next dose is due.
43
Advantage of Intermittent Infusion
- Prevent harm to the PT - med is given slowly - high serum blood level for only a short period of time - Multiple admin of med the through a single line - Reduce risk of high infusion
44
Reconstitution
Mixing powdered med with a diluent -powder to liquid

N243 (3 decks)

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