Module 1: Part 2 - NT-CVC Flashcards
Complications of vascular access devices:
know at least 5
- Catheter damage
- Occlusion
- Infct/sepsis
- Dislodgment
- Catheter migration
- Skin erosion
- infiltration/extravasation
- Pneumothorax
- Incorrect placement
What to assess for catheter damage/breakage?
- Every shift observe for pinholes, leaks, tears
- Assess for drainage from site after flushing
How to prevent catheter damage?
- Proper clamping
- Avoid sharps near
- Use needleless system
- 10mL syringe preferred for flushing to avoid excessive
pressure - Never flush against resistance
Interventions for catheter damage?
- Clamp near insertion site and apply sterile gauze over
break or hole until repaired - Remove catheter with order
What to assess for occlusion?
- Blood return
- Ability to infuse liquids
- Discomfort or pain in shoulder, neck, ear, or arm at
insertion site - Neck or shoulder edema
Prevention of occlusion?
- 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
Interventions for occlusion/
- 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
Why should you not use a 1mL syringe to instill saline in a CVAD?
Because this exceeds 200 psi
What to assess for infct/sepsis?
- Skin junction for signs of local or systemic infct
- Monitor labs
How to prevent infct/sepsis?
- Use aseptic technique
- Proper dressing type and changes
Interventions for infct/sepsis?
- Obtain blood cultures ?
- Remove ?
- Replace
What to assess for dislodgement?
- Length
- Identify edema or drainage
- Palpate skin junction for coiling
- Distended neck veins
How to prevent dislodgement?
- Make sure catheter is very secure
- Avoid pulling
- Avoid manipulating catheter by hand (maybe try by
foot instead ;P)
Interventions for dislodgement?
- Replace
- Teach pt not to manipulate as much as possible
What are 3 examples of catheter migration?
- 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
What to assess for with catheter migration?
- 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
How to prevent catheter migration?
- Avoid trauma
- Avoid placement near site of local infct, scarring, or
skin disorder
Interventions for catheter migration?
- Preposition under fluoroscopy ?
- Remove ?
- Stop fluid admin
What is skin erosion?
Mechanical loss of skin tissue
What is cuff extension?
Tissue at edges of insertion site separate
What to assess for skin erosion, cuff extrusion, or scar tissue over port?
- 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
How to prevent skin erosion, cuff extrusion, or scar tissue over port?
- 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
Interventions for skin erosion, cuff extrusion, or scar tissue over port?
- Remove CVAD as ordered
- Improve nutrition
- Appropriate skin care
What to assess for infiltration/extravasation?
- 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
How to prevent infiltration/extravasation?
- Immediately stop infusion
- Admin antidote or therapeutic meds to maintain tissue
integrity
Interventions for infiltration?
- Apply cold/warm compress
- Emotional support
- X-ray ?
- Discontinue IV solutions
What to assess for pneumothorax, hemothorax, air emboli, hydrothorax?
- 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
How to prevent pneumothorax, hemothorax, air emboli, hydrothorax?
- 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
- If hubs must be open to air ensure the clamps are
Interventions for pneumothorax, hemothorax, air emboli, hydrothorax?
- 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 ?
What to assess for incorrect placement?
- Dysrhythmias
- Hypotension
- Neck distension
- Narrow pulse pressure
- inadequate blood withdrawal
- Retrograde flow of blood
What is retrograde flow of blood?
Flow of blood back into tubing, usually caused by dec pressure gradient between venous system and access device unit
How to prevent incorrect placement?
- Obtain X-ray exam after placement
- Reposition catheter as warranted
Interventions for incorrect placement?
- Stop fluid admin
- Discontinue catheter ?
- Obtain X-ray and ECG
- Admin support meds as needed
When should you flush a CVAD?
- Immediately prior to starting infusion
- At least every 7 days
