module 4- part A (peripheral vascular access device) Flashcards
complications of a short peripheral catheter/ peripherally inserted central catheter?
- tourinquet retention
- tubing and catheter misconnections
- phlebitis
- air embolism
- device fragment embolization
- inadvertent discharge with a retained PVAD
peripheral venous access device=
PVAD
-either a short peripheral catheter or a peripherally inserted central catheter
infections are often attributed to what at the SPC site
phlebitis
what can reduce the harm of SPC associated infections?
-early recognition of phlebitis, prompt removal of related device, ongoing monitoring of the inflamed access site after removal
which are most common SPCs or PICCs
SPC
what are PICCS?
perpiherally inserted central catheter
-30 to 40 cm long, inserted into upper extremity and terminate in vena cava
factors that lead to greatest risk of SPC complications?
- lack of standardized technique
- variations in practice
- communication backdowns
- insufficient knowledge and skills among providers
PICCS have a high risk of?
deep vein thrombosis
which patients are at most risk of tourinquet retention?
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
tubing or catheter misconnection?
- components on wrong medical device attached
- high risk
- sometimes permanent injury
prevention of tubing or catheter misconnection?
- limit unnecessary disconnections, visualize connectors with good lighting
- label tubing distally and proximally
- use devices only as intended
- never force connections
- educate pt /family
detection of tubing or catheter misconnection?
- maintain awareness of possibility of misconnection events such as CV, resp, neuro
- reconcile connections after transfers or transport
- recognize warning signs of misconnections (forcing)
what is phlebitis?
occurs when chemical, mechanical, or particulate-induced irritations promote local inflammation of the vein wall
most common complication of SPC?
phlebitis, may develop up to 48 hrs after removed
PICCs and phlebitis?
- 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
risk factors of phlebitis?
- 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)
prevention of phlebitis?
- 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)
detection of phlebitis?
- inspect cather site and proximal vascular pathway regularly
- use transparent dressings
- monitor site for at least 48 hours after removal
signs of phlebitis?
inflammation of vein
-local pain, swelling, tender, local or streaking erythema
air embolism?
inadvertent venous administration of air via intravenous access device or insertion site
signs/symptoms of air embolism?
-dyspnea suddenly, cough, wheezing, chest & or shoulder pain, agitation and more
air embolism is commonly associated with?
-CVC placement or removal but also occurs with insertion and use
is there a safe volume of venously administered air?
no not right now
fatal volume of air in humans?
50mL but 20mL delivered rapidly can be fatal
risk factors to air embolism?
- 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
recovery of air embolism?
-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
device fragment embolization?
migration of part of a damaged vascular device through the vascular system
-may lodge in peripheral venous system, right ventricle, or pulmonary vasculature
risk factors for device fragment embolization?
- anatomical compression of PICC between clavicle and first rip
- suboptimal placement technique resulting in damage
- use of undersized syringue or unsanctioned power injection (barotrauma)
prevention of device fragment embolization?
- 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
recovery from device fragment embolization?
- retain device for exam
- chest x ray
- report and disclose
unintentional discharge with a retained PVAD?
-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!
clincal scenarios resulting in air embolism?
- 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)
infiltration=
inadvertent administration of a nonvesicant solution into subq tissue instead of intended vascular tissue
extravasation=
infiltration of a vesicant (an agent “capable of blistering, tissue sloughing, or necrosis”) into subq tissue instead of vascular tissue
purpose of IV and vascular access therapy?
-provide parenteral nutrition, blood products, route for hemodynamic monitoring, diagnostic testing, fluids, meds, w/ abaility to rapidly change blood conc evels
principles for practice of IV and vascular access therapy?
- success depends on patient prep, site selection, cath selection and insertion
- assess pt anatomy and physiology of circulatory system, fluid, electrolyte balance, etc
isotonic solutions=
same osmolarity as body fluid
when would isotonic solutions be used?
fluid volume deficit because hemorrhage, diarrhea, vomiting
hypertonic solutions?
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
hypotonic solution?
SWELL
pulls fluid into the cell
-because cell has more solute than the outside of cell
-would use for intracellular dehydration, NOT CEREBRAL EDEMA
isotonic osmolarity=
same tonicity/osmolarity as blood and other serums (230-375 mOSm/L)
D=
dextrose
W=
water
S=
saline
RL=
ringers lactaid
LR=
lactated ringers
fluid volume deficit=
decreased urine output, dry mucous membranes, decreased cap refil, disparity in central and peripheral pulses, tachycardia, hypotension shock
fluid volume excess=
dyspnea, crackles in lung, edema, increased urine output
electrolyte imbalances=
- abnormal serum electrolyte levels
- changes in mental status
- alterations in NT function, cardiac arrhythmias, changes in vitals
hypotonic osmolarity=
lower tonicity or osmolarity than blood or other serums (less than 250 mOsm/L)
hypertonic osmolarity=
higher tonicity or osmolarity than blood or other serums (more than 375 mOsm/L)
solution additives?
KCl often added
IV sites?
-vein in arm, leg, or sometimes a scalp vein in infants
rate of infusion in peripheral veins should not exceed?
200ml in 1 hour
when blood transfusions or replacement is needed..
larger vein preferred
what vein for central?
subclavian or internal jugular
PICC use peripheral vein to..
access central vein
-usually cephalic, basilic, or brachial
flow in central lines is determined by?
-diameter of catheter, length of line,
monitoring IV?
generally checked every 30 mins for an hour for volume remaining fluids and correct infusion rate
primary IV tubing?
involves a drip chamber, one or more injection ports, a roller clamp
-squeeze drip chamber until it is approx half full of IV fluid
secondary IV tubing?
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
IV flow rates are ordered by?
prescriber
-usually mL/h, gtt/min
physical assessment of fluid, electrolyte, acid base balances?
-assessing fluid intake and output: daily weight, outtake, intake
daily intake should = output + 500
nursing diagnostic process of deficient fluid volume?
- 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
crystalloids?
- dextrose, sodium chloride, lactaid ringers
- solutes mix, dissolve and cross semipermeable membranes
parenteral replacement of fluids and electrolytes is through?
admin of crystalloids, colloids, and total parenteral nutrition
total parenteral nutrition is?
-hypertonic consisting of glucose, other nutrients, and electrolytes
colloids?
proteins and starchs stay in extracellular space- increase vascular volume in critical situations
pressure of IVs?
positive pressure
PVAD duration?
keep in as long as it is not showing signs of malfunctioning
to accurately measure the patients weight, the nurse must?
- ensure pt is wearing same clothes each time
- use the same scale each time
how often should an IV be assessed?
every hour, but more frequently if known irritant
what can affect the IV flow rates?
- position of the IV site in an area of flexion
- changes in position of patient
- manipulation of IV device
what should the nurse do if the patient did not receive the prescribed fluid amount?
consult with doctor and get a new order to provide necessary fluid
