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243 > p&P CVAD > Flashcards

p&P CVAD Flashcards

1
Q

where is CVAD tip of catheter terminate

A

in lower thrd of superior vena cava and junction of R atrium

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2
Q

where does tip of catheter terminate when inserted from femoral region

A

inferior vena cava above diaphragm

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3
Q

is an open ended or closed ended CVAD more likley to have complication

A

open ended

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4
Q

how do you maint patency of implanted venous port

A
  • Implanted venous ports are located within the reservoir pocket and there are therefore no external lumens to which to attach admin sets or flush syringes
  • Flush implanted venous ports monthly w 3-5ml of heparin to maint patency
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5
Q

which CVADs are short term

long term

A

nontunneled percutaneous
PICCS

long term: external tunneled (Hickman, Broviac, Groshong)
implanted venous ports

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6
Q

nontunneled percutaneous

Length of dwell
Insertion site
Insertion technique

A

Nontunneled percutaneous
length of dwell:Days to several weeks

Insertion site: Subclavian, int/ext jugular, femoral

Insertion technique: Not sx. Bedside. Directly punctures intended vein without passing through subcut tissue

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7
Q

external tunneled

Length of dwell
Insertion site
Insertion technique

A 
External tunnelled (Hickman, Broviac, Groshong)
length of dwell:permanent

Insertion site: Chest region via sublvian or jugular vein

insertion techniqueSx: tunnelling of the proximal end subcut from insertion site and bringing it out through skin at an exit site

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8
Q

PICC

length of dwell
insertion site
insertion technique

A

PICC

length of dwell:Until complic dev or no longer fx well

Insertion site: Antecubital fossa or upper arm (basilica or cephalic vein) and advanced until catheter tip reaches superior vena cava

Insertion technique: Can be inserted at bedside or home, radiology

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9
Q

implanted venous port

length of dwell
insertion site
insertion technique

A

Implanted venous port

length of dwell: permanent

Insertion site:Chest, abd, inner aspect of forearm

Insertion technique: Sx: placed via subclavian or jugular vein and attached to reservoir located within a subcutaneous pocket

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10
Q

assessment for CVAD insertion

A

.• Order, med etc,
-hydration, i/o,
-surgical procedures of upper chest or anatomic irreg of proposed insertion site,
-skin of area
-consent
• Allergy to: iodine, lidocaine, latex chlorhexidine
• Type of Cvad intended for placement. Read manufacturers directions
• If CVAD already in assess the fx of the CVAD; integrity of catheter, ability to flush or infuse fluid, ability to aspirate blood
• Need to flush? Drsg change?
• Pt knowledge?
(marilyn adds VS q30min x 2)

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11
Q

how should pt be positioned for PICC/midline

or other CVC drsg change/site care

A

• If PICC or midline device pos pt w arm extended. If other type have pt comfy w head elevated

i think that they should be facing away from the device when site is exposed so they dont cough on it etc

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12
Q

cvad gauze drsg vs transparent drsg. how long should you wait between drsg changes

A

• If using transparent drsg give care every 5-7 days and as needed

if gauze q48hrs and prn

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13
Q

what to assess CVAD for when about to do drsg change

A

• If CVAD already in assess the fx of the CVAD; Measure before and after doing everything ,integrity of catheter, ability to flush or infuse fluid, ability to aspirate blood.

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14
Q

primary complication assoc w CVADs

A

usually referred to as central line assoc bloodstream infections (CLABSIs) d/t contaminationfrom the skin of pt or from poor infection prevention during insetion or care

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15
Q

pt postion for insertion of nontunnedled device (Ins of ND)

rationale

A

dr and nurse put pt in Trendelenburg.

or supine pos for jugular or subclavian plcement

place rolled towel bet pt shoulder blades, rotate them slightly to 10 degree angle
-turn pt head away from insetion site

-head down below heart enc max filling and distension with inc in diameter of subclavian vein

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16
Q

catheter insertion: nontunneled device

maybe not nec since we dont insert them but we may have o help… coursepack says “ understand assessment of pt prior to CVAD insertion. and care after CVAD insertion”

A 
-position pt
•	Hand hygiene w antiseptic soap 60 sec
•	Use clippers if nec
•	Drape under area to be cannulated
•	Scrub pt w chlorhexidine for 30 sec then
•	Hysician preps her equipment
•	Nurse preps IVbag, primes et
•	Wipe lidocine so surgeon can inject it
it will now be inserted. What should be done by pt during/bfore insertion?
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17
Q

who is trendelenburg contra for

A

pt with inc ICP, head injury, some spinal injuries and resp issues

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18
Q

what to do just before time of insertion

A

ask pt to hold breath and strain (valsalva maneuver which inc CVP and prevents air entry into catheter)

19
Q

what to do if pre insettion of nontunneled CVAD te pt wont do their valsalva maneuver

A

if this doesnt work pt may hum and hold breath

if unbale to do either, compress the pts abdomen gently

20
Q

pt is holding their breath for insertion of nontunneled device
steps of insertion and nurses role

what must happen before the nurse can perform his role and why

A
  • Dr inserts IV, determines patency, may suture it in or secure it with manufactured stabilization device
  • Nurse adjusts IV infusion to prescribed rate and connects it AFTER XRAY (theres inc risk of pneumothorax w insertion. dont want to put high flow fluids through)
21
Q

whats neessary before removal of catheter stablization device

when would this be removed

A

alcohol

for insertion site care and drsg change

22
Q

INSERTION SITE CARE AND DRSG CHANGE assessments before doing

A

Order, med etc, hydration, i/o, surgical procedures of upper chest or anatomic irreg of proposed insertion site, skin of area
• Allergy to: iodine, lidocaine, latex, chlorhexidine

23
Q

insertion site care and drsg change procedure

A

Implementation of insertion site care and drsg change
• If PICC or midline device pos pt w arm extended. If other type have pt comfy w head elevated
• If using transparent drsg give care every 5-7 days and as needed if gauze q48hrs and prn
• w gloves remove old drsg (in direction of catheter insertion, pull it that way)
• Inspect insertion and surrounding skin
• Meas mid arm circumference above insertion site. (youre looking for thrombosis)
• Measure length of catheter
• Set up sterile field for CVAD drsg kitSterile gloves
• Cleanse w chlorhexidine. Vertical then opp 30 sec. Dry 30 sec.
• Skin protectant to whole area. Let dry.
• Use chlorhexidine impregnated drsg for short term CVADs
• Apply new securement device if not sutured
• Apply transparent semipermb drsg or gaue drsg over site (these msut be sterile)
• Label w drsg, date, time, initials

24
Q

when to change injection cap

A

• Usually changed min q7 days or if blood present, when integrity compromised, w each admin set change

25
Q

CHANGING INJECTION CAP PROCEDURE

A

Changing injection cap
• Usually changed min q7 days or if blood present, when integrity compromised, w each admin set change
• Wash hands
• Prep caps clean septum of cap w antiseptic soln using friction.
o Keep protective cap on tip of injection cap
o : prime w 0.9% ns. Keep syringe attached
• Clamp catheter lumens one at a time to prevent air entry 0r have pts do valsalva manuver during cap change
• Take off old injection caps using aseptic technique
• W gloves cleanse catheter hub and connect new injection cap on catheter hub
• Flush w 10ml!! Psi is nec. NaCl 0.9% then heparin

26
Q

flushing a positive pressure device

A

Flusing positive pressure device
• Prep syringe, prime through device by attaching prefilled saline syringe. Prime through device ad leave syringe attached
• Clamp catheter if nec and remove injection cap and discard
• Flush like normal. Reclamp when exerting pressure on syringe
• (it doesn’t say add another injection cap but I assume we do.

27
Q

what to do if nurse is trying to add extension set to flush

A

this doesnt work for positive pressure action of the valve. cant use this

28
Q

d/c PICC or nontunneled catheter

A

not sure how much we have to know. advanced practice RNs can do this. I started pg 732 at step O.

  • apply petroleum ointment to site
  • sterile occlusive drsg/gauze drsg
  • label drsg w date time initials
  • inspect catheter integrity and dispose
  • return pt to comfortable position. Be sure that short peripheral IV or midline is infusing at correct rate
29
Q

after nontunneled catheter or PICC removal how often do you change drsg

A

q24h until healed

30
Q

what to assess after CVAD insertion

A

Eval
• Is line still nec? (do this every day)
• Complic indicative of pneumothorax: pain, SOB, absent breath sounds
• Monitor for bleeding or swelling at insertion site or neck and occlusiveness of drsg (this indicates infiltration into subcut tissue
• I/O, electrolyte balance,
• VS (infect?),
• site,
• catheter connection points, tubing for kinks, obstr, cracked hubs
• clot filtration in catheter, air embolism, catheter migration
• pt understanding
• Look at xray if avail

31
Q

how to document pt CVAD removal

A 
pt position
-appearance of site
-length of catheter removed
-integrity of catheter removed
drsg applied
-pt tolerance
bleeding? monitor q15min for 1hr
-probems during removal
32
Q

how can you stabilize a short peripheral IV drsg

A

• Can stabilize w: manuf stabilization device, sterile tapes, sx strips, cover w TSM or gauze

33
Q

how often to change gauze drsg of peripheral IV

A

q48hr and immed if compromised

34
Q

assess before changing peripheral IV drsg

A

-IV assessment
-pt for signs of infection
when was it changed last

35
Q

CHANGING SHORT PERIPHERAL IV DRSG procedure

A

• Remove TSM w stretch technique by pulling laterally and stabilizing catheter. repeat on other side
• Ig gauze remove one layer at a time
- prep your new sterile tape for securement
• In both cases leave tape that secures VAD to skin in place during removal of the drsg then remove w chlorhexidine swab vertical then horizontal then from insertion site outward w a third swab. Allow to dry
-apply drsg
-(i assume we add tape here but i couldnt see where we should do this0
• Record time change, reason, type of drsg material used, patency of system, description of venipuncture site

36
Q

consideration for placement of drsg over IV

A

the connection between the administration set and hub needs to be uncovered to facilitate changing tubing if nec

37
Q

where should tape not go when periph IV drsg change

A

dont put it over the transparent drsg (i guess we put it under then??)

38
Q

pilliteri
how does a dacron cuff stay in place

what type of CVAD would this be found on

A

it is a wrinkle resistant fabric that adheres to the subcut tissue

found on external tunneled eg HIckman, broviac, groshong

39
Q

disadvantage from piliteri regarding external tunneled catheter

A

it could get pulled out and the kid could lose lots of blood

40
Q

which type of device is likely to be well accepted by children and why

what is a drawback of this type of CVAD

A

implanted port-can have full range of activities eg swimming, no external drsg, not as visible

it requires puncture with access

41
Q

where are PICCS well suited (what general population)

A

good for home care because they only need to be changed every 4 months

42
Q

where would a midline insertion rest according to piliteri

A

the tip rests close to the head of the clavicle

43
Q

do parents prefer PICCs or other CVCs and why

A

PICCs because they look more like regular IVs

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