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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
Q

Infection

A

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
Q

PT related risk factors for infection

A
  • Immuno suppressed
  • Neutropenia
  • Poor nutrition
  • Renal failure
  • Chronic Infection
  • Diabetes
  • Short bowel syndrome
  • Self-care deficit: poor hygiene and ability to manage care
27
Q

Phlebitis

A

Inflammation of one or all three layers of the vein wall

Types:
1 Mechanical
2 Chemical
3 Bacterial

28
Q

Venous Thrombosis

A

Normal physiological response to a foreign body, such as a CVAD.
Caused by aggregation of platelets and accumulation of fibrin

29
Q

S+S of Venous Thrombosis

A

-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
Q

Catheter migration causes

A
  • 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
Q

S+S of catheter migration

A
  • 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
Q

Air embolus

A
  • 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
Q

S+S Air Embolus

A
  • Hypoxia, rapid onset of SOB, coughing , anxiety
  • Hypotension
  • Cyanosis
  • Palpitations or arrhythmias, weak rapid pulse
  • Chest and shoulder pain
  • Loss of consciousness
34
Q

IV Meds Admin Types

A
  • Intermittent infusion
  • IV direct/push
  • IV Bolus
  • Continuous Drip Infusion into the main primary IV bag
35
Q

Compatibility IV Meds

A

Drug to Diluent
Drug to Primary Solution
Drug to Drug

36
Q

IV Meds advantages

A

Unconscious PT med admin
Quick therapeutic effect of med
Control of how much to give, stop or hold
Constant absorption

37
Q

IV Meds disadvantages

A
  • Rapid severe reaction to med
  • Fluid overload
  • IV site complications: speed shock-drug builds up becomes toxic, anaphylaxis,…
38
Q

Anaphylaxis s+s

A 
Swelling
Angioedema
Nause
Confusion
Stridor
Hypotension
Tachycardia
39
Q

Anaphylaxis Prevention

A
  • Allergy screening
  • Antidote
  • Teaching
  • Diligent checking
40
Q

Anaphylaxis Intervention

A
  • 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
Q

IV Drug Monograph

A

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
Q

Intermittent Infusion

A

An infusion of a volume of fluid/med over a set period of time, then is stopped until the next dose is due.

43
Q

Advantage of Intermittent Infusion

A
  • 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
Q

Reconstitution

A

Mixing powdered med with a diluent -powder to liquid

N243 (3 decks)

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