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N243 > Module 1- CVAD's > Flashcards

Module 1- CVAD's Flashcards

1
Q

how do CVADs differ from short peripheral or midline catheters?

A

CVADs tip ends in the larger blood vessel

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2
Q

where should the tip of the CVAD be placed?

A

in the upper body in the lower segment of the superior/inferior VC at or near the cavoatrial junction

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3
Q

if a CVAD is placed in the lower part of body, where should the tip end?

A

in the inferior vena cava above the level of the diaphragm

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4
Q

what area is a CVAD not recommended for adults?

A

in the femoral region

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5
Q

list the factors when determining the placement of a CVAD

A

○ Type and duration of infusion therapy (greater than 7 days)
○ Vascular characteristics
○ Patients age
○ Co-morbidities
○ History of infusion therapy
○ Preference for VAD location
-pH and osmolarity of the solution or medication to be administered

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6
Q

what is the nurses role?

A

○ Anticipate patients need for CVAD
○ Assist the health care provider in placing a CVAD
○ Care for, and maintain the device
○ Administer solutions or medications
-Assess for S+S of IV related complications

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7
Q

catheter tip configurations can either be __ or __?

A

can be open ended or valve ended

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8
Q

what are open ended devices?

A

they have a catheter tip that is open like a straw

ex. hickman, broviac

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9
Q

what are valve ended devices?

A

have a rounded catheter tip with a three way pressure activated valve that prevents reflux of blood into the catheter to reduce the risk of hemorrhage, air embolism, and occlusion
ex. groshong

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10
Q

how many lumens do CVAD’s have?

A

single or multiple lumens

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11
Q

how do you activate a valve?

A

positive pressure from syringe

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12
Q

what determines the number of lumens someone has

A

depends on patient’s condition and prescribed therapy

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13
Q

what does more than one lumen indicate?

A

patients requiring numerous infusions and blood samplings that allows simultaneous administration of solutions and medications and allow for admin of incompatible solutions or medications at the same time

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14
Q

what is an implanted venous port?

A

a CVAD that has a reservoir placed in a pocket under the skin with the catheter inserted into a major vessel (ex. Subclavian)

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15
Q

does the implanted venous port have an external lumen/hub?

A

no, instead you access this port by inserting a special 90 degrees angle noncoring needle through the skin into the self sealing injection port in the septum of the reservoir

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16
Q

a port should not be used for?

A

for extended periods (weeks) between infusions and it is not necessary that the port remain accessed during these periods

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17
Q

how do you maintain patency of the implanted venous ports?

A

flush monthly with heparin or NS

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18
Q

what type of infections can CVADs cause

A

local or systemic

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19
Q

where can a local infection develop?

A

around the catheter insertion site

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20
Q

how can a systemic infection develop

A

through contamination of the catheter from the skin of the patient or poor infection prevention practices during insertion, care and maintenance

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21
Q

list the two short term CVAD devices

A
  • nontunneled percutaneous

- peripherally inserted central catheters (PICCs)

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22
Q

list the two long term CVAD devices

A
  • external tunneled (hickman, broviac, groshong)

- implanted venous ports

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23
Q

how long can a non-tunneled percutaneous CVAD stay in place?

A

days to several weeks

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24
Q

how long can a PICC stay in place

A

as long as they function properly with no evidence of IV related complications

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25
Q

how long can external tunneled and impanted venous ports stay in?

A

both considered permanent

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26
Q

what is the insertion technique for a non-tunneled percut?

A

not surgically placed; can be done at beside; direct puncture into intended vein without passing through subQ tissue

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27
Q

what is the insertion technique for a PICC?

A

not surgically placed: can be done at bedside, in home setting, or radiology setting

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28
Q

how are both short term devices held in place?

A

with sutures or engineers securement device

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29
Q

insertion sites for nontunneled?

A

subclavian, external/internal jugular and femoral veins

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30
Q

insertion sites for PICCs?

A

antecubital fossa or upper arm and advanced until catheter tip reaches superior vena cava

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31
Q

whats the insertion technique for an external tunneled?

A

surgery required; tunneling of proximal end subcutaneously from insertion site and bring it out through skin at an exit site

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32
Q

insertion technique for implanted venous ports

A

requires surgery; catheter placed via subclavian or jugular vein and attached to reservoir located within a surgically created subQ pocket

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33
Q

insertion sites for external tunneled

A

chest region through subclavian or jugular vein

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34
Q

insertion sites for implanted venous ports

A

chest, abdomen, or inner aspect of forearm

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35
Q

how is the external tunneled held in place

A

Held in place by a dacron cuff coated in antimicrobial solution; in approx 2-3 weeks scar tissue forms around cuff, fixing catheter in place

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36
Q

how is an implanted venous port held in place

A

Sutured in place within surgically created pocket and accessed using a noncoring needle through the skin

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37
Q

how long should infusion be turned off for before taking a blood sample?

A

atleast 1-5 minutes (IH is 5 minutes)

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38
Q

if you cannot stop the infusion, what do you do?

A

you draw blood from a peripheral vein

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39
Q

when drawing blood from a multi lumen catheter, which lumen is preferred?

A

distal lumen

40
Q

how long do you scrub injection cap with alcohol for?

A

min 15 seconds and LET DRY

41
Q

what size syringe do you attach and how much discard blood do you withdraw?

A

5 ml syringe (10 ml with NS for VIHA)

-you withdraw 4-5ml’s (6ml’s for adults from CVAD association and 3mls for peds)

42
Q

how many ml’s do you flush from your 10ml syringe before aspirate?

A

you flush 5ml and then aspirate for blood return

43
Q

after you aspirate, what do you do?

A

you withdraw and discard a minimum of 6 mL of blood for adults and 3mL for pediatric patients; discard into biohazard container

44
Q

after you draw up your discard blood, what do you do?

A

you clear hub for another 15 seconds and attach a new 10ml syringe and un-clamp line to obtain desired amount of blood for specimen (repeat this step if needing more than 10ml’s)

45
Q

what is the technique and specific rule for flushing blood?

A

clean cap for another 15 seconds and flush with TWO 10ml syringes for a total of 20ML’s using push pause technique!!

46
Q

what do you do if the cap does not clear after flushing with 20mls?

A

you change cap

47
Q

what is something to remember in regards to flushing and lumens?

A

once you flush one lumen, you have to flush them all! but you only flush remaining lumens with 10 ml’s

48
Q

how often should injection caps be changed?

A

no more frequently than 9 hour intervals

49
Q

why is an xray done after admin of a CVAD?

A

to ensure and confirm the position of catheter tip and presence of pneumothorax**

50
Q

what is the beginning procedure for performing a blood culture draw?

A
  • clamp line if applicable and take off cap
  • scrub HUB for 15 seconds and and attach empty 10ml syringe
  • NO PREFLUSH OR DISCARD IS DONE
  • aspirate amount of blood needed
51
Q

how many ml’s do you need to use to flush for a blood culture draw?

A

20ml’s !! its blood, its always 20 but cleansing between syringes

52
Q

what do you do once you’ve flushed for your blood draw?

A

cleansing all caps and flushing all other lumens. dont bottom out flush

53
Q

when are short term or non tunneled catheters used?

A

used in acute care, emergency, and critical care units

54
Q

can PICCs be trimmed?

A

yes, before insertion and decision can be made to insert the catheter midline (between the insertion site and axilla)

55
Q

what do you need to make sure of if the catheter is midline?

A

TPN or any med that is known to irritate a peripheral vein (chemo) should not be administered

56
Q

where should a high concentration of glucose in the TPN be administered?

A

should be infused through a central catheter due to irritation to the vessel

57
Q

when is the decision to start a PICC made and why

A

needs to be made before several attempts to start an IV are made. this is because antecubital veins are not considered candidates for this type of catheter once they have been punctured repeatedly

58
Q

how many lumens do long term CVADs have

A

single, double or triple lumens

59
Q

what must be done on the port with the implanted device?

A

must be palpated for placement and stabilized, overlying skin cleared and only special noncoring huber needles used to pierce the port’s diaphragm on the top or side

60
Q

how often are huber needles changed?

A

at established intervals usually 5-7 days

61
Q

what are the two most common complications of CVADs

A

infection and catheter occlusion

62
Q

what are CVADs used for?

A

IV meds, or IV’s that are longer term (greater than 3-7 days), hemodialysis, repetitive blood sampling, blood administration, TPN, med’s that are irritants

63
Q

is a non tunneled percutaneous/CVC open or valve system?

A

open system with clamps

64
Q

what tells a nurse its an open system?

A

has clamps**

65
Q

are PICCs an open or valved system?

A

valved system!! there are no clamps

66
Q

when are PICCs assessed?

A

every shift, before treatment, or before flushing/doing a med, if it’s red/irritated

67
Q

how much of an external segment shift of a PICC is allowed? adults and peds

A

up to 5cm shift for adults, 1cm for peds

68
Q

how often is a transparent dressing changed?

A

every 7 days

69
Q

gauze dressing is changed?

A

every 2 days

70
Q

how often do we flush a PICC?

A

every 7 days

71
Q

t or f: BP is allowed to be taken on side of PICC

A

FALSE: NO not allowed

72
Q

what does a nurse need to know before going in to assess a CVAD

A 
• Look at chart/care plan
• Does this patient still need this?
• What type of CVAD?
• X-ray confirmation
• External segment measurement- Check care plan to see length inside**
• When is flushing required? 
-Dressing change?
-Is IV fluid running?
73
Q

if a patient has an occlusion, what can you do to intervene?

A

reposition pt, have pt cough and breathe deep, raise arm overhead

74
Q

what do you do if you sense a patient experiencing an air emboli?

A

put them in trendelenburg on their left side so the air doesn’t go into the lungs and can stay in the atrium

75
Q

what do you need to know about syringe sizes for a CVC?

A

never use a syringe less than 10ml because of the pressure being too high

76
Q

What is the most common complication of CVADs?

A

infection

77
Q

What is the most life threatening complications of NT-CVC’s?

A

Air emboli

78
Q

List 3 possible causes of an air embolism in a NT-CVC:

A

○ Not applying clamps when removing needle free connectors
○ Line fracture
-Inhaling during cap change (deep inspiration during removal)

79
Q

List three things a nurse can routinely do to minimize the chance of air entering the system when working with a NT-CVC

A
  • Ensure the lumen is clamped prior to opening the system
  • Keep a blue clamp or padded forcep with patient in case of catheter breakage
  • Use Luer lock connections
  • Having patient perform Valsalva maneuver (forcible exhalation against a closed glottis) when removing because risk of air embolism is high
80
Q

S+S of an air embolism include

A

Anxiety, loss of consciousness, sudden onset of chest pain, shoulder pain, palpitations, weak rapid pulse, etc

81
Q

what are your nursing interventions for someone with an air emboli

A 
§ Trendelenburg position immediately and place on left side with head down
§ Clamp Iv
§ Call for help/ code blue possibly
§ call doctor
§ Admin O2
§ Assess VS, breath sounds
Document
82
Q

It is not necessary to have sutures in place to secure a CVAD. T/F

A

TRUE

83
Q

what is the sandwich technique?

A

flushing of an existing IV line or vascular access device with saline pre and post administration to avoid the mixing of incompatible solutions or medications

84
Q

S+S of speed shock

A 
 Dizziness
 Facial flushing
 Headache
 Irregular heart rate
 Sudden onset of symptoms associated with the administration of the medication
85
Q

locations for where CVADs can be placed?

A

internal/external jugular, subclavian, basilica and brachial vein

86
Q

why is the distal lumen preferred for blood sampling?

A

usually the biggest and less blood clotting and aggregation

87
Q

what CVAD is best for blood sampling?

A

PICC

88
Q

list the pt-related risk factors for infection

A
  • Immune suppressed
  • Neutropenia
  • Poor nutrition
  • Renal failure
  • Chronic infection
  • Diabetes
  • Short bowel syndrome
  • Self-care deficit, poor hygiene and ability to manage care
89
Q

what CVAD is most likely to lead to mechanical phlebitis and why

A

PICC’s are most likely to be effected by mechanical phlebitis due to the insertion site, the catheters passage along a smaller peripheral vein and movement of the upper arm muscles

90
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 or abdomen
•Pain around the catheter insertion, shoulder or jaw ache •Difficulty breathing
•Discolouration of the skin in the upper body, or cyanosis in the hand or arm

91
Q

what is catheter migration

A

occurs when the internal catheter tip changes position with or without the external length changing

92
Q

causes of catheter migration

A

-vomiting , coughing, sneezing , heavy lifting , changes in thoracic pressure
Heart failure
Presence of tumours
Mechanical ventilation
Securement dressing of device is not intact or become wet and loose

93
Q

what is a catheter fracture?

A

A break or tear in the catheter can be caused by forceful flushing, pinch off syndrome or accidental cutting of the catheter

94
Q

S+S of 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

95
Q

define infiltration

A

Misdirection of intravenous fluid or medication from the vein into the interstitial tissue

96
Q

define extravasation

A

The inadvertent infiltration of a irritant/vesicant solution or medication into surrounding tissue

N243 (2 decks)

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