Seminar #8: IV Push Meds + PICC Lines Flashcards
What the conditions for IV push
- volume less than 20mL
- rate appropriate for staying @ bedside to monitor
- medication approved this way by pharmacy
- LPNs don’t give IV push meds d/t higher risk involved w/ possible immediate medication SEs d/t faster administration than a secondary line
- when given in a CVAD (e.g., PICC), the vessel is much larger and some medications can be given IV push
Difference between PVAD & PICC (CVAD)?
<7-10 days: PVAD short
7 days-1 month: PVAD extended dwell or PVAD midline
more than 1 month, but less than 1 year: PICC
more than 1 yr/ LT: IVAD or tunneled CVAD
- increased assessments + monitoring w/ central line, e.g., PICC, d/t incr invasiveness of it + location of device
Peripheral vs Central medications (PVAD/CVAD)
Certain meds are better to be given in larger vessel, so PICC line or CVAD are recommended due to their vesicant/ irritating properties
cause? s/s?
CVAD - PICC Complications: Catheter occlusion
cause:
- clamped or kinked catheter
- tip against wall of vessel
- thrombosis
- precipitate buildup in lumen
s/s:
- sluggish infusion or aspiration
- unable to infuse and/or aspirate
Cather occlusion - interventions
PICC complications (CVAD)
- instruct pt to change position, raise arm, and cough
- assess for + alleviate clamping or kinking
- flush w/ NS using 10mL syringe; don’t force flush
- fluoroscopy to determine cause + site
- anticoagulant or thrombolytic agents
PICC Complications: Embolism (air, catheter, or thrombus)
cause:
- catheter breaking
- dislodgement of thrombus
- entry of air into circulation
s/s:
- CP
- respiratory distress (dyspnea, tachypnea, hypoxia, cyanosis)
- hypotension
- tachycardia
Embolism - Interventions?
PICC complications
- clamp catheter
- place pt on left side w/ head down (if suspect air emboli)
- administer oxygen
- notify physician
Air embolism - what to do?
mechanism of death/injury depends on size of air embolism + where it lodges in body
- if air bubble travels to brain, heart, or lungs, it can cause MI, CVA, or respiratory failure
- if venous air embolism, place pt on L side in trendelenburg position (encourages air bubble to move into R atrium, preventing CV collapse)
- if arterial air embolism, pt should be kept in supine flat position
Catheter embolism - how + prevention?
- breakage of piece of catheter than occludes or travels into venous system
- size of syringe to prevent damage to vein –> want min 10 cc syringe, the smaller, the greater the pressure
Cause + S/S?
PICC Complications: Catheter related infections - local or systemic
cause:
- contamination during insertion or use
- migration of organisms along catheter
- immunosuppressed pt
s/s:
- local: redness, tenderness, purulent drainage, warmth, edema
- systemic: fever, chills, malaise
- culture of drainage from site (redness, oozing)
- warm, moist compresses
- catheter removal if indicated
Catheter Related Infections - Systemic Interventions
- blood cultures
- antibiotic therapy
- antipyretic therapy
- catheter removal if indicated
Cause + S/S?
PICC Complications: Pneumothorax/ Hemothorax
cause:
- inadvertent puncture of lung or pleura @ time of inserting needle into vein
- one of most common complications of central venous catheter (CVC) insertion
s/s:
- decr or absent breath sounds
- respiratory distress (cyanosis, dyspnea, tachypnea)
- cp
- distended unilateral chest
- decr or absent breath sounds
Pneumothorax/Hemothorax interventions
- position in semi-fowler’s position
- administer o2
- administer analgesics if ordered
- prepared for xray/chest tube insertion
- call MRP stat
cause + s/s?
PICC Complications: Catheter Migration
cause:
- improper suturing
- insertion site trauma
- changes in intrathoracic pressure
- forceful catheter flushing
- spontaneous
s/s:
- sluggish infusion or aspiration
- edema of chest or neck during infusion
- client complaint of gurgling sound in ear
- dysrhythmias
- incr external catheter length
catheter migration: intervention
- fluoroscopy to verify position
- assist with removal + new CVAD placement
- sometimes sutured in to prevent migration risk
cause + s/s?
PICC complications: arrhythmia
cause:
- line advances into right atrium irritating heart
s/s:
- palpitations or pounding in the chest
- tachycardia/bradycardia
- chest pain / discomfort
- shortness of breath
- weakness, fatigue, dizziness
Arrhythmia interventions
- medications (e.g., anti-arrhythmic, anticoagulant, anti-platelet)
- vasovagal maneuvers
- cardioversion/defibrillation/pacing
- catheter procedures (ablation)
- pacemaker (permanent, implantable defibrillator)
- heart surgery (valve, bypass)
- removal = first option for treatment
How to assess PICC external length?
- for PICCs w/ visible 0 measure, measure from 0 to insertion site
- PICCs w/o visible markings, measure from hub to insertion site
Assessing PICC Catheter Size + Gauge
gauge size:
- gauge size varies inversely with OD - the higher the gauge size, the smaller the OD
french size:
- begins at zero, each increment of 1 french unit represents an increase of 1/3 mm in OD
single, double, or triple lumen
dougle = nice for blood draw
triple = can run incompatible meds + run blood draw
3 Additional checks for IV meds
- dilution - does medication need to be diluted?
- compatibility w/ other fluids/meds in same IV line (if not listed, assume incompatible)
- rate/duration - how long is med administered over?
IV Push Meds Considerations/ Alerts
- never use pre-filled saline syringes for meds
- never pre-draw meds into syringe for later administration
- document assessment of all med sites post-med admin
- document all responses to PRN meds
How much to flush when aspirating and after med?
aspiration: 3-5mL PVAD or 10mL PICC
after med: 10mL PVAD, 20mL PICC
- first 5-10 mL should be given at same rate as med, and second 5-10mL should be given w/ push-pause technique
How to give IV push med into an incompatible solution (PVAD)
- if running IV not compatible with med, IV needs to be stopped and line flushed before + after med w/ 10mL NS
- med not diluted during administration
- IV line clamped/pinched, then flushed before med w/ 10 mL normal saline (includes patency check)
- IV line remains clamped while medication is given at correct rate
- with IV line clamped, IV line then flushed after med w/ 10 mL NS
- line unclamped, tubing unclamped, then IV pump restarted
