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n242 > module 4- part A (peripheral vascular access device) > Flashcards

module 4- part A (peripheral vascular access device) Flashcards

1
Q

complications of a short peripheral catheter/ peripherally inserted central catheter?

A
  • tourinquet retention
  • tubing and catheter misconnections
  • phlebitis
  • air embolism
  • device fragment embolization
  • inadvertent discharge with a retained PVAD
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2
Q

peripheral venous access device=

A

PVAD

-either a short peripheral catheter or a peripherally inserted central catheter

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3
Q

infections are often attributed to what at the SPC site

A

phlebitis

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4
Q

what can reduce the harm of SPC associated infections?

A

-early recognition of phlebitis, prompt removal of related device, ongoing monitoring of the inflamed access site after removal

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5
Q

which are most common SPCs or PICCs

A

SPC

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6
Q

what are PICCS?

A

perpiherally inserted central catheter

-30 to 40 cm long, inserted into upper extremity and terminate in vena cava

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7
Q

factors that lead to greatest risk of SPC complications?

A
  • lack of standardized technique
  • variations in practice
  • communication backdowns
  • insufficient knowledge and skills among providers
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8
Q

PICCS have a high risk of?

A

deep vein thrombosis

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9
Q

which patients are at most risk of tourinquet retention?

A

those who cant express symptoms reliably.

  • assessments reduce harm!
  • signs and symptoms: pain, numb, edema, leaking, poor infusion
    prevention: long, bright tourinquets, do not roll up patients sleeves or palce over clothing, keep visible
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10
Q

tubing or catheter misconnection?

A
  • components on wrong medical device attached
  • high risk
  • sometimes permanent injury
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11
Q

prevention of tubing or catheter misconnection?

A
  • limit unnecessary disconnections, visualize connectors with good lighting
  • label tubing distally and proximally
  • use devices only as intended
  • never force connections
  • educate pt /family
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12
Q

detection of tubing or catheter misconnection?

A
  • maintain awareness of possibility of misconnection events such as CV, resp, neuro
  • reconcile connections after transfers or transport
  • recognize warning signs of misconnections (forcing)
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13
Q

what is phlebitis?

A

occurs when chemical, mechanical, or particulate-induced irritations promote local inflammation of the vein wall

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14
Q

most common complication of SPC?

A

phlebitis, may develop up to 48 hrs after removed

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15
Q

PICCs and phlebitis?

A
  • chemical irritants are rare
  • most commonly in antecubital fossa
  • catheter damage permits infused material to infiltrate into tissues more peripherally–> local irritation
  • fibrin sheath can develop
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16
Q

risk factors of phlebitis?

A
  • pt related: age, female, fragile, poor quality veins, neoplasms, immunocompromise
  • use relation (antecubtial fossa or lower extremities site)
  • device related (large catheter, poorly secured, in place for more than 72-96 hours)
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17
Q

prevention of phlebitis?

A
  • only select cath size and location on basis of planned therapy
  • use vein visualization technique to properly select site
  • use specifically designed catheter stabilizing devices to reduce mechanical irritation and protect device integrity
  • reduce limb motion
  • avoid placement in areas mentioned early
  • replace SPCs as directed (72-96 hrs)
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18
Q

detection of phlebitis?

A
  • inspect cather site and proximal vascular pathway regularly
  • use transparent dressings
  • monitor site for at least 48 hours after removal
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19
Q

signs of phlebitis?

A

inflammation of vein

-local pain, swelling, tender, local or streaking erythema

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20
Q

air embolism?

A

inadvertent venous administration of air via intravenous access device or insertion site

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21
Q

signs/symptoms of air embolism?

A

-dyspnea suddenly, cough, wheezing, chest & or shoulder pain, agitation and more

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22
Q

air embolism is commonly associated with?

A

-CVC placement or removal but also occurs with insertion and use

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23
Q

is there a safe volume of venously administered air?

A

no not right now

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24
Q

fatal volume of air in humans?

A

50mL but 20mL delivered rapidly can be fatal

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25
Q

risk factors to air embolism?

A
  • patient: hypovolemia, asymptomatic PFO, neonates with PFO
  • use related (difficulty in identifying air embolism due to non-specific signs and symptoms, misperceptions that infusion devices will always alarm if air in line)
  • device related (large bone venous cath insertion site above heart, physical properties of infusion tubing that promote entrainment of air
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26
Q

recovery of air embolism?

A

-immediately start treatment, occlude suspected site, place pt in left trendelenburg or left lateral decubitis position, deliver oxygen 100% via face mask, attempt to aspirate air from catheter, report to physician

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27
Q

device fragment embolization?

A

migration of part of a damaged vascular device through the vascular system
-may lodge in peripheral venous system, right ventricle, or pulmonary vasculature

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28
Q

risk factors for device fragment embolization?

A
  • anatomical compression of PICC between clavicle and first rip
  • suboptimal placement technique resulting in damage
  • use of undersized syringue or unsanctioned power injection (barotrauma)
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29
Q

prevention of device fragment embolization?

A
  • examine vascular devices carefully before insertion
  • recognize precursor and early signs/symptoms (swelling, pain, leakage)
  • do not remove a PICC against resistance
  • avoid antecubital fossa
  • protect all vascular devices from twisting, bending, entanglement
  • limit use of scissors
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30
Q

recovery from device fragment embolization?

A
  • retain device for exam
  • chest x ray
  • report and disclose
31
Q

unintentional discharge with a retained PVAD?

A

-increases patient risk for phlebitis, bleeding, thrombosis, or infection
-leave before final assessment by a nurse
determine when, in the discharge process, PVADS should be removed!
-be explicit about final checks, visually inspect!

32
Q

clincal scenarios resulting in air embolism?

A
  • administration through IV access device (most common!)
  • tubingmisconnection (accientally attach air tube)
  • catheter or hub damage
  • entrainment of infused material
  • after removal of a VAD (improper technique)
33
Q

infiltration=

A

inadvertent administration of a nonvesicant solution into subq tissue instead of intended vascular tissue

34
Q

extravasation=

A

infiltration of a vesicant (an agent “capable of blistering, tissue sloughing, or necrosis”) into subq tissue instead of vascular tissue

35
Q

purpose of IV and vascular access therapy?

A

-provide parenteral nutrition, blood products, route for hemodynamic monitoring, diagnostic testing, fluids, meds, w/ abaility to rapidly change blood conc evels

36
Q

principles for practice of IV and vascular access therapy?

A
  • success depends on patient prep, site selection, cath selection and insertion
  • assess pt anatomy and physiology of circulatory system, fluid, electrolyte balance, etc
37
Q

isotonic solutions=

A

same osmolarity as body fluid

38
Q

when would isotonic solutions be used?

A

fluid volume deficit because hemorrhage, diarrhea, vomiting

39
Q

hypertonic solutions?

A

SRHINK
pull fluid out of the cell and into the extracellular space
-inside to out
-solution has more solute than the cell does
-would use with hyponatremia or cerebral edema

40
Q

hypotonic solution?

A

SWELL
pulls fluid into the cell
-because cell has more solute than the outside of cell
-would use for intracellular dehydration, NOT CEREBRAL EDEMA

41
Q

isotonic osmolarity=

A

same tonicity/osmolarity as blood and other serums (230-375 mOSm/L)

42
Q

D=

A

dextrose

43
Q

W=

A

water

44
Q

S=

A

saline

45
Q

RL=

A

ringers lactaid

46
Q

LR=

A

lactated ringers

47
Q

fluid volume deficit=

A

decreased urine output, dry mucous membranes, decreased cap refil, disparity in central and peripheral pulses, tachycardia, hypotension shock

48
Q

fluid volume excess=

A

dyspnea, crackles in lung, edema, increased urine output

49
Q

electrolyte imbalances=

A
  • abnormal serum electrolyte levels
  • changes in mental status
  • alterations in NT function, cardiac arrhythmias, changes in vitals
50
Q

hypotonic osmolarity=

A

lower tonicity or osmolarity than blood or other serums (less than 250 mOsm/L)

51
Q

hypertonic osmolarity=

A

higher tonicity or osmolarity than blood or other serums (more than 375 mOsm/L)

52
Q

solution additives?

A

KCl often added

53
Q

IV sites?

A

-vein in arm, leg, or sometimes a scalp vein in infants

54
Q

rate of infusion in peripheral veins should not exceed?

A

200ml in 1 hour

55
Q

when blood transfusions or replacement is needed..

A

larger vein preferred

56
Q

what vein for central?

A

subclavian or internal jugular

57
Q

PICC use peripheral vein to..

A

access central vein

-usually cephalic, basilic, or brachial

58
Q

flow in central lines is determined by?

A

-diameter of catheter, length of line,

59
Q

monitoring IV?

A

generally checked every 30 mins for an hour for volume remaining fluids and correct infusion rate

60
Q

primary IV tubing?

A

involves a drip chamber, one or more injection ports, a roller clamp
-squeeze drip chamber until it is approx half full of IV fluid

61
Q

secondary IV tubing?

A

used when giving medications

  • piggybacked onto primary line
  • generally shorter and contains a drip chamber and roller clamp
  • hung higher than primary IV to allow secondary set of med to infuse first
62
Q

IV flow rates are ordered by?

A

prescriber

-usually mL/h, gtt/min

63
Q

physical assessment of fluid, electrolyte, acid base balances?

A

-assessing fluid intake and output: daily weight, outtake, intake
daily intake should = output + 500

64
Q

nursing diagnostic process of deficient fluid volume?

A
  • assess BP and pulse
  • obtain daily weight
  • observe volume of urine output and measure intake, and gravity
  • assess skin turgor, ask patient if thirst or weak
  • inspect mucous membranes for degree of moisture
65
Q

crystalloids?

A
  • dextrose, sodium chloride, lactaid ringers

- solutes mix, dissolve and cross semipermeable membranes

66
Q

parenteral replacement of fluids and electrolytes is through?

A

admin of crystalloids, colloids, and total parenteral nutrition

67
Q

total parenteral nutrition is?

A

-hypertonic consisting of glucose, other nutrients, and electrolytes

68
Q

colloids?

A

proteins and starchs stay in extracellular space- increase vascular volume in critical situations

69
Q

pressure of IVs?

A

positive pressure

70
Q

PVAD duration?

A

keep in as long as it is not showing signs of malfunctioning

71
Q

to accurately measure the patients weight, the nurse must?

A
  • ensure pt is wearing same clothes each time

- use the same scale each time

72
Q

how often should an IV be assessed?

A

every hour, but more frequently if known irritant

73
Q

what can affect the IV flow rates?

A
  • position of the IV site in an area of flexion
  • changes in position of patient
  • manipulation of IV device
74
Q

what should the nurse do if the patient did not receive the prescribed fluid amount?

A

consult with doctor and get a new order to provide necessary fluid

n242 (7 decks)

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