Part A: Peripheral Vascular Access Device Indications & Assessment Flashcards
steps in flushing a PVAD
- Equipment: Sterile saline syringe, alcohol swab
- Scrub top of site for 15 seconds, let it dry
- Get air bubbles out of syringe
- Inject (3-5mL), push pause (turbulent blood flow)
- At the last 0.5mL close camp shut while injecting last of saline solution to put positive pressure in
complications of PVADs?
- tourniquet retention
- tubing and catheter misconnections
- phlebitis
- air embolism of device fragments
- inadvertent and thrombosis
- PVAD infiltration and extravasation
whats the first step in minimizing complications?
selection of appropriate device and insertion site
what is most common symptoms with short peripheral catheters (SPC)?
phlebitis
what is the FATAL amount of air thats needed for an embolism?
50mL max is fatal!! 20mL can be lethal if delivered rapidly
what can happen if theres an unintentional discharge of a PVAD?
increase a patient’s risk for phlebitis, bleeding, thrombosis, or infection
what is the purpose of IV therapy ?
- Provide parenteral nutrition
- Transfuse blood products
- Provide a route for hemodynamic monitoring and a route for diagnostic testing
- Administer fluids and medications
what are the two types of VAD’s
- PVAD’s
- CVAD’s
what are the types of PVAD’s?
short peripheral and midline
what are the types of CVAD’s?
tunnelled, non-tunnelled, PICC, implanted port
what is the location of VAD’s based on?
where the tip of the device resides
what do you need to consider when selecting the appropriate VAD?
• Prescribed therapy • Length of treatment • Duration the device remains in place • Vascular characteristics • Patients age • Co-morbidities • History of infusion therapy • Preference for VAD location -Resources available to care for the device
what are the three types of osmolarities?
isotonic, hypotonic, hypertonic
isotonic solutions
- the same tonicity or osmolarity as blood and other body serums. Stays in intravascular system
- can cause increased risk for fluid overload in those with renal or cardiac disease
hypotonic solutions
- lower tonicity or osmolarity than blood and other body serums. Shifts from vascular system into interstitial components
- can exacerbate a hypotensive state
hypertonic solutions
- higher tonicity or osmolarity than blood or other body serums. Shifts from interstitial to vascular system
- irritating to the vein and can cause increased risk of heart failure and pulmonary edema
to prevent infusion-related complications, what site should you administer solutions with an osmolarity greater than 900mOsm/L?
should be infused through a CVAD
what site should not be used for vesicant therapy, parenteral nutrition, or infusates with an osmolarity greater than 900mOsm/L?
short peripheral catheters
what patient teaching should be included with a VAD?
• care of the VAD
• Infection prevention
• Potential complications
-Any signs and symptoms to report
how often should SPC be assessed?
every 4 hours or more if indicated
how often should CVADs be assessed and changed?
atleast daily and changed every 5-7 days for TSM dressings and atleast every 2 days for gauze dressings
what would indicate the need to change a dressing?
damp, loosened, and/or visibly soiled
what are you assessing the VAD site for?
redness, tenderness, swelling, and drainage by visual inspection and palpation through the intact dressing
what are expected outcomes of inserting a VAD?
-VAD remains patent and site is free from S+S of IV-related complications
• Vital signs are stable
• Fluid and electrolyte
-balance returns to normal
-Patient is able to explain purpose and risks of IV therapy
what do you want to know if an IV catheter becomes occluded?
occluded catheters should not be flushed because an embolus can form**
what are the two methods to IV administration?
continuous and intermittent
what is continuous IV administration
replace or maintain fluid and electrolytes and are also used to administer
what are VAD’s?
-they are catheters, cannulas, or infusion ports designed for repeated access to vascular system
are Central venous catheters (PICCSs), meant for short or long term use?
long term use or for admin of medication or solutions that are irritating to veins
is a midline catheter (inserted in upper) short or long term use?
short term (recommended for 1-4 weeks)
IV therapy is used for?
- dehydration
- burns
- antibiotics
- chemotherapy
what is turbulent flush?
the push pause method
what is intermittent IV therapy?
site is hooked up and established but IV is not infusing
what is continuous IV therapy?
site is always infusing
at what times do you flush an IV?
before administering medications and after administering medications
do you flush intermittent IV or continuous?
flush only intermittent
why do you flush?
to maintain patency. patency means its working
how much normal saline do you flush with?
3-5mL
what do you always wanna ensure when flushing an IV
that you end on positive pressure (air going in, instead of out)
what do you do if you come in and witness patient SOB and their hands feel tight?
you’d immediately slow the flow rate and then do a focussed assessment to check other issues
