Module 1: CVADs, Part 1: PICC Flashcards
What is a CVAD?
- radio opaque tube inserted in a central vein used to administer high volume fluids and medications, parenteral nutrition, venous blood sampling
factors that influence the type of CVAD?
- reason (diagnosis)
- length of therapy
- placement risk to pt
- availability of resources to help the family maintain the catheter
Types of CVADS?
- short-term or nontunnelled catheters
- PICCs
- long-term central CVADs: tunnelled catheters, implanted infusion ports
What is a PICC and what is it used for?
- short-term to moderate length therapy
- silicone or polymer material
What is the most common insertion site for a PICC?
- above the antecubital area using the median, cephalic or basilic vein and is threaded into the vena cava
What cannot be administered if PICC is inserted at midline?
TPN because the glucose in TPN will irritate the vein
At what point would someone not be considered for a PICC?
when the vein has been punctured several times
Nursing alert for PICC lines>?
They are not sutured in place, so care must be taken when changing dressing
What should the nurse do if the PICC is accidentally removed?
If a central venous catheter is removed accidentally, apply
pressure to the entry site to the vein, not the exit site on
the skin.
nursing alert for CVAD?
When working with CVADs, avoid using scissors
around the tubing or dressing and remove carefully with fingers.
Parent and child teaching for CVADs:
o Preparation and injection of med.
o Flush.
o Dressing changes.
Two most common complications for CVADs?
- infxn and catheter occlusion
- pt requires abx and fibrinolytic agent
how can uncapping be prevented>?
by taping the cap securely to the catheter and the
clamped line to the dressing.
How can leaks be prevented?
using a smooth-edged clamp only
How can you tell the difference between valved and non-valved catheter?
If clamps are present on the external
segments the catheter is non-
valved ,it requires clamping
when removing syringe to prevent reflux of blood into the catheter and when changing needless connectors to prevent air embolus and loss of blood.
Post insertion intervention for PICC?
- apply warm compress if there’s discomfort
- no strenuous activity for 24hrs for risk of bleeding
Initial dressing intervention for PICC?
- changed 24h following insertion, only if gauze applied at insertion
site. - Due Date: ___________
If a CHG impregnated sponge or CHG dressing is used change every 7 days. - Reapplication of the impregnated dressing or sponge is not required.
Assessment and documentation for PICC? (every shift/CHS with pt visits)
- Assess for redness, swelling, drainage, or discomfort
- Connections are secure
- Dressing is dry and occlusive (secure to skin) (infxn and security)
- Measure external segment:
Outward movement of 5cm or more (adults) and 1cm or more (children) required CX to confirm placement of tip
If PICC migrates inwards, pull back to original external segment. Does not require CX
Transparent dressing change for PICC?
Change transparent dressing every 7 days days and immediately if loose, wet, or soiled
Gauze dressing change for PICC?
Gauze dressing every 2 days and immediately if loose, wet, or soiled
Needle free connector change?
Every 7 days, or if removed for any reason or cannot be flushed clear post blood draw, or contamination
Tubing change for Continuous Infusion?
Primary and secondary lines every 96hrs (4 days)
- label applied for change
Tubing change for intermittent Infusion?
Primary and secondary lines every 24hrs (daily)
- label applied for change
When catheter is not in use, how often should all lumens be flushed?
every 7 days
