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N243 > Module 1: Part 2 - NT-CVC > Flashcards

Module 1: Part 2 - NT-CVC Flashcards

1
Q

Complications of vascular access devices:

know at least 5

A
  • Catheter damage
  • Occlusion
  • Infct/sepsis
  • Dislodgment
  • Catheter migration
  • Skin erosion
  • infiltration/extravasation
  • Pneumothorax
  • Incorrect placement
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2
Q

What to assess for catheter damage/breakage?

A
  • Every shift observe for pinholes, leaks, tears

- Assess for drainage from site after flushing

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3
Q

How to prevent catheter damage?

A
  • Proper clamping
  • Avoid sharps near
  • Use needleless system
  • 10mL syringe preferred for flushing to avoid excessive
    pressure
  • Never flush against resistance
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4
Q

Interventions for catheter damage?

A
  • Clamp near insertion site and apply sterile gauze over
    break or hole until repaired
  • Remove catheter with order
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5
Q

What to assess for occlusion?

A
  • Blood return
  • Ability to infuse liquids
  • Discomfort or pain in shoulder, neck, ear, or arm at
    insertion site
  • Neck or shoulder edema
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6
Q

Prevention of occlusion?

A
  • Routine flushing with positive pressure
  • Secure to prevent tension on CVAD
  • 10mL syringe preferred to avoid excessive pressure
  • Don’t flush against resistance
  • Flush between meds
  • Flush vigorously after viscous solutions
  • Avoid mixing incompatible drugs
  • Avoid kinking catheter
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7
Q

Interventions for occlusion/

A
  • Reposition pt
  • Have pt cough and deep breathe
  • Raise pt’s arm overhead
  • Obtain venogram ? (? = if ordered)
  • Thrombolytics ?
  • Remove catheter ?
  • X-ray ?
  • Do not use 1mL syringe to instill saline
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8
Q

Why should you not use a 1mL syringe to instill saline in a CVAD?

A

Because this exceeds 200 psi

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9
Q

What to assess for infct/sepsis?

A
  • Skin junction for signs of local or systemic infct

- Monitor labs

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10
Q

How to prevent infct/sepsis?

A
  • Use aseptic technique

- Proper dressing type and changes

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11
Q

Interventions for infct/sepsis?

A
  • Obtain blood cultures ?
  • Remove ?
  • Replace
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12
Q

What to assess for dislodgement?

A
  • Length
  • Identify edema or drainage
  • Palpate skin junction for coiling
  • Distended neck veins
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13
Q

How to prevent dislodgement?

A
  • Make sure catheter is very secure
  • Avoid pulling
  • Avoid manipulating catheter by hand (maybe try by
    foot instead ;P)
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14
Q

Interventions for dislodgement?

A
  • Replace

- Teach pt not to manipulate as much as possible

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15
Q

What are 3 examples of catheter migration?

A
  • Length of catheter moved from original position
  • Pinch-off syndrome (compression of catheter between
    clavicle and rib)
  • Port separation/catheter fracture (internal fracture or
    separation of catheter
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16
Q

What to assess for with catheter migration?

A
  • Pt complaints of gurgling sound
  • Patency of catheter
  • Pain at site
  • Symptoms of embolus
  • X-ray examination
  • Edema on hand or arm at site of insertion
  • Distended neck veins
  • length of catheter
17
Q

How to prevent catheter migration?

A
  • Avoid trauma
  • Avoid placement near site of local infct, scarring, or
    skin disorder
18
Q

Interventions for catheter migration?

A
  • Preposition under fluoroscopy ?
  • Remove ?
  • Stop fluid admin
19
Q

What is skin erosion?

A

Mechanical loss of skin tissue

20
Q

What is cuff extension?

A

Tissue at edges of insertion site separate

21
Q

What to assess for skin erosion, cuff extrusion, or scar tissue over port?

A
  • Loss of viable tissue over septum site
  • Separation of exit site edges
  • Drainage at catheter skin junction
  • Edema, contusions
  • Note if tunneled catheter is exposed
22
Q

How to prevent skin erosion, cuff extrusion, or scar tissue over port?

A
  • Maintain nutritional status
  • Avoid pressure trauma
  • Rotate with each port access
  • Do not reinsert a noncoring needle in the same hole as
    a previous insertion, creates permanent hole
  • Do not use standard needle to access port
23
Q

Interventions for skin erosion, cuff extrusion, or scar tissue over port?

A
  • Remove CVAD as ordered
  • Improve nutrition
  • Appropriate skin care
24
Q

What to assess for infiltration/extravasation?

A
  • Erythema
  • Edema
  • “Spongy” feeling
  • Swelling around IV site and termination of catheter tip
  • Labored breathing
  • Aspiration of fluid and/or blood
  • complaints of unpleasant sensation with infusion of
    solutions
25
Q

How to prevent infiltration/extravasation?

A
  • Immediately stop infusion
  • Admin antidote or therapeutic meds to maintain tissue
    integrity
26
Q

Interventions for infiltration?

A
  • Apply cold/warm compress
  • Emotional support
  • X-ray ?
  • Discontinue IV solutions
27
Q

What to assess for pneumothorax, hemothorax, air emboli, hydrothorax?

A
  • SubQ emphysema by inspecting and palpating skin around insertion site and along arm.
    • Inspection may reveal edema where air is located
    • Palpating reveals a crackling/popping sensation
  • Chest pain
  • Dyspnea, apnea, hypoxia, tachycardia, hypotension,
    nausea, confusion
28
Q

How to prevent pneumothorax, hemothorax, air emboli, hydrothorax?

A
  • Use injection cap on distal end when not in use
  • Do not leave hub open to air
    • If hubs must be open to air ensure the clamps are
      closed
29
Q

Interventions for pneumothorax, hemothorax, air emboli, hydrothorax?

A
  • Admin O2 ?
  • Elevate feet
  • Aspirate air, fluid
  • If air emboli is suspected, place pt on L side with head
    down
  • Remove ?
  • Aid with insertion of chest tubes ?
30
Q

What to assess for incorrect placement?

A
  • Dysrhythmias
  • Hypotension
  • Neck distension
  • Narrow pulse pressure
  • inadequate blood withdrawal
  • Retrograde flow of blood
31
Q

What is retrograde flow of blood?

A

Flow of blood back into tubing, usually caused by dec pressure gradient between venous system and access device unit

32
Q

How to prevent incorrect placement?

A
  • Obtain X-ray exam after placement

- Reposition catheter as warranted

33
Q

Interventions for incorrect placement?

A
  • Stop fluid admin
  • Discontinue catheter ?
  • Obtain X-ray and ECG
  • Admin support meds as needed
34
Q

When should you flush a CVAD?

A
  • Immediately prior to starting infusion

- At least every 7 days

N243 (6 decks)

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