Seminar #7: IV infusion meds + PICC lines Flashcards
1
Q
IV Medications Parenteral Admin Rights
A
- right dilution
- right compatibility
- right rate of administration
2
Q
what is a PICC?
A
- central line inserted into peripheral vein
- usually inserted in cephalic, basilic, or median cubital vein above ACF
- tip of catheter rests in lower portion of distal superior vc
- IV nurse inserts PICC using ultrasound machine @ bedside, 30-45min; location of tip needs to be verified via cxr
- frequently for treatments expected to last >1 month, < 1 year
- may be valved/non-valved
- may be single lumen, double lumen, or triple lumen
2
Q
Additional Rights for an Infusion Device
A
e.g., IV pump, PCA, epidural, syringe pump
- right infusion device
- right protocol
- right program settings
2
Q
Importance of central venous access device (CVAD) tip position
where should it be located?
A
- tip of catheter should be located within lower 3rd of superior vc
- catheters positioned within heart have an incr risk of mortality
- catheter tips positioned perpendicular to vein wall have incr risk of vessel erosion, hydrothorax, hydromediastinum, tamponade, and extravasation
- nurses should never use CVAD until tip position confirmed
3
Q
What are valved CVADs?
A
- venous access device with an internal (integrated) valve or device located @ either proximal/distal end
- valve allows infusion + aspiration thru VAD, but it remains closed when not in use –> prevents back flow and providing safety mechanism
- no need for routine clamping/heparinizing
3
Q
how does non-valved PICC work?
A
- venous access device without an internal (integrated) valve/ device
- has a clamp to prevent reflux or back flow of fluid contents or blood
- require saline lock to keep patent
4
Q
PICC: Power Injectable - what is it?
A
- purple central venous catheter that allows power injection of contrast media for scans
- have max rate of 5 mL/sec
- usually all lumens are 18 gauge
- usually are non-valved
4
Q
CVADs: advantages of multi-lumens
A
- if more than 1 lumen, usually at least 1 lumen is @ different gauge (e.g., 19g, 20g, 20g)
- may administer multiple meds/treatments at same time
- may give multiple incompatible medications @ same time
- need to flush each lumen (regardless of use), usually qshift to maintain patency
4
Q
CVAD Ports/Port openings
A
- multi-lumen catheter has diff port openings at end of catheter
- each lumen often has diff colour hub, color depends on manufacturer (e.g., sometimes red/brown used for blood)
- distal touches blood first, never touching each other
5
Q
Indications for PICC:
A
- administer IV fluids + blood products (including administering large volumes of IV fluids quickly)
- administer meds (including vasopressor/vasodilator therapy)
- administer vesicants (e.g., chemotherapy)
- administer irritants (e.g., cloxacillin)
- admin solutions w/ exterme pH values (e.g., vancomycin)
- admin hypertonic solutions (e.g., TPN - higher dextrose content may be infused thru CVAD)
- obtain venous blood samples
6
Q
Role of nurse for cvad
A
- ensure asepsis w/ all central lines + venous access ports
- assess site for redness, drainage, swelling, pain, tenderness, warmth, numbness, parasthesia
- ensure patency of all PICC/CVADs before use
- assess PICC dressing
- check external length of PICC
- assess for CVAD complications
7
Q
How to ensure patency of PICC/CVAD before use
A
- perfom flushes
- check for resistance on aspiration, ability to withdraw bood, ability to infuse fluids w/o resistance
- start-stop flush technique, never flush with force
- if unable to aspirate blood gently, flush CVAD w/ 1-2mL NS, then re-attempt
- use min 2x volume of catheter and add-on devices
- use 10mL or greater syringe for flushing to decr risk of catheter damage. doesn’t apply when using power-injectable lines - lock line after use with saline (st CVAD), or heparin (LT CVADs)
- patency check qshift to ensure line is correctly placed, patent + ready to use
- if not flushing/unable to aspirate, notify IV team asap
8
Q
How many mL to flush PICC?
A
patency: 10mL
After meds: 20 mL
8
Q
PICC flush, lock with heparn 100 units/mL
A
CVAD tunneled: 3mL
IVAD: 5 mL
9
Q
Checking external length of PICC
A
- to ensure correct placement
- measured w/ qdressing change + prn if concerns
- measure PICC external length q24h (acute care)
- measure from IV site to thicker hub of line (counting each 1cm segment marking on line) + document
- compare length of external portion of catheter w/ its previously documented length
- if >2cm different from initial measurement, report to IV team asap
10
Q
Assessing PICC dressing
A
- assess that PICC dressing is dry + intact
- needs to be changed if damp, loosened, or visibly soiled, or if moisture, drainage, or blood is present under dressing
- transparent dressing changed q7 days + prn (gauze changed q2 days)
- securement device changed q7 days + prn
- needleless cap changed q7 days, prn, and when unable to clear blood from cap
- use chlorhexidine for cleaning site e.g., >0.5% chlorhexidine w/ alc
11
Q
what are some CVAD complications?
A
- infection
- occlusions: thrombotic, chemical, mechanical
- phlebitis, thrombophlebitis, infiltration, extravasation
- catheter migration
- pulmonary embolism
- air embolism
- catheter embolism
- pneumothorax/hemothorax
- arrhythmia
12
Q
what is it?
IV med admin: Direct IV (IV push, bolus)
A
- administration of small volume med (max 20 mL) pushed manually into pt using syring leur-locked to a needleless port of IV line
12
Q
what are some complications that are rare in peripheral lines, but more common in central lines?
A
- air embolus
- cathter embolus
- pneumothorax/hemothorax (less risk w/ PICCs)
- arrhythmia
13
Q
what is it?
IV med admin: intermittent infusion (secondary, mini-bag)
A
- slow release of medication given intermittently into bloodstream through IV line
- usually contains meds that are supplied in a smaller infusino bag and mixed with diluent fluid like saline
14
Q
what is it?
IV med admin: Continuous infusion
A
- administration of medication through IV catheter that is continuously delivering substance into the body via IV pump
15
Q
Key points of IV med infusion / IV push med?
A
- receive doc order for IV med
- needs to determine if drug may be given direct IV, intermittent, or continuous infusion
- need to determine if drug needs to be diluted
- rate of admin needs to be determined
- check compatibility of solution before giving med
16
Q
What is a diluent?
A
- ingredient in medicinal preparation that lacks pharmacologic activity, but is pharmaceutically necessary/desirable
- mixed w/ medication powder in vial to reconstitute to a liquid for drawing up in a syringe
- must ensure diluent used is compatible with med
- e.g., NS, sterile water for injection (SWFI), dextrose 5% in water (D5W)
17
Q
How to determine amount of medication needed to draw up from reconstituted powder vial?
A
- read vial to determine how much diluent to add to vial to get med concentration written on vial
- usually need to add __ mL diluent to vial to make _ mg/ ____mL of med
18
What do you add to medication label for mini bag?
- date
- time
- drug name
- drug dose
- concentration
- base solution
- rate of administration
- patient name/BD
- nurse initials
19
IH Policy: do you remove fluid or no when adding medication to an infusion bag?
- if volume of additive is 10% or more of bag volume, the equivalent volume must be withdrawn from diluent bag first and then discarded
- e.g., if adding 11.6 mL of med to minibag, will need to remove 11.6 mL first so the total volume will be 100 mL
20
Heparin considerations
- no IM d/t risk of bleeding
- baseline PTT then 6h after initial heparin bolus and any dosage change
- baseline CBC + platelet count q2 days
- dopamine = protamine sulfate
- initial heparin therapy (based on weight)
21
how to determine loading / IVP bolus dose?
(desired/have) x supply
- based on weight
- don't give bolus if heparin/LMWH was given in past 6h
22
how to determine concentration of medication in bag?
concentration of additive in IV fluid = units of additive/volume of IV fulid
e.g.,
25,000 units/500 mL = 50 units/mL
23
how to determine rate of admin for continuous infusion, mL/hour
rate of infusion (units/h) = rate of infusion (mL/h) x concentration of additive in IV fluid (units/mL)
e.g., rate of infusion in ml/h if ordered rate is 1100 units/h?
1100 units/h = ____ (mL/h) x 50 units/mL
= 1100 units/50 units/ml = 22 mL/h
24
What needle to use if injecting heparin into infusion bag?
- use non-filter needle if used filter needle to draw up med
25
Steps to administer heparin bolus IV push, and start heparin infusion through PVAD/PICC
1. give heparin IV push bolus through saline lock
- pre-med flush (3-5mL PVAD, 10ml PICC), post-med flush (10mL PVAD, 20mL PICC)
2. hang heparin infusion
3. start infusion
4. document on mar, vad record, I/O record
26
how often to change IV tubing set? decision-making is based on what?
change q96h, excluding lipids, blood, and blood products
decision-making based on:
- infection prevention
- physical safety
- patient preference
- clinical knowlege + beliefs
- workload
27
What is tandem infusion?
- second IV line connected to primary line @ lower port (below pump)
- **connected below pump**
- med can be given intermittently or at same time as primary infusion (e.g., both bags infuse @ same time if compatible)
28
considerations for open ends of tubing + syringes
- don't leave end caps off of IV tubing at any time
- DO NOT remove end cap while priming IV tubing
- if tubing end-caps removed, maintain strict aseptic technique while connecting needless port/line
- ensure open ends of syringes remain sterile by keeping blunt fill needle + cover/cap on until use
- don't touch open-end of syringe to any non-sterile object
- if needing to temporarily disconnect IV line, may use blue cap, blunt fill needle, or white cap of saline flush (if not contaminated)
