seminar 9 Flashcards

1
Q

where is a PICC usually inserted

A

usually inserted into a vein above the ACF (the ditch)

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2
Q

should you take blood pressure on the arm where there is a PICC

A

NO

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3
Q

How long are non tunneled CVADS used for

A

usually left in place less than 7 days but can be used for up to one month

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4
Q

how is a non tunneled CVAD inserted into a PT

A

inserted surgically by a physician and sutured in place since there is a risk for excessive bleeding if it is pulled out

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5
Q

where are non tunneled CVADs usually inserted

A

into the internal/external jugular or subclavian vein

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6
Q

What kind of CVAD would be used for long term access

A

a tunneled CVAD

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7
Q

how long is a tunneled CVAD used for

A

usually used for treatments that are expected to last longer than one year since they can be left in place indefinitely

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8
Q

how does a tunneled CVAD stay in place and have a better chance of not becoming infected

A

since it has a dacron cuff which 3-4 weeks after insertion granulation tissue will grow onto and create a seal and barrier to infection

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9
Q

Which CVAD requires a sterile dressing a tunneled or non tunneled

A

non tunneled since it needs a barrier to protect the site from infection

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10
Q

what type of CVAD requires heparin flushing tunneled or non tunneled

A

tunneled CVAD requires heparin flush

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11
Q

where is the end of the catheter located on an IVAD

A

usually placed in the distal third of the superior vena cava

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12
Q

when is a dressing required for an IVAD and what type of dressing

A

is only required when in use and it can just be an aseptic dressing

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13
Q

Does an IVAD require heparin flushing

A

YES

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14
Q

How often does an IVAD need to be heparin flushed when not in use

A

every 1-3 months

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15
Q

Where is the tip of the catheter located in a CVAD

A

located in the lower third of the superior vena cava

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16
Q

what kind of access device would be used for TPN

A

CVAD

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17
Q

how often does the tubing for TPN need to be changed

A

every 24 hours

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18
Q

what extra piece of equipment is required for TPN administration

A

requires and inline filter to be administered

19
Q

Which lumen should be used when drawing blood from a CVAD

A

the largest one usually there is a red one that will be for blood

20
Q

how often do you need to access a CVAD if it is running a continuous infusion

A

need to access the CVAD every hr while its running a continuous infusion

21
Q

How often do you need to access a CVAD if it is saline/heparin locked

A

once a shift

22
Q

how often do you need to measure the external length of a PICC

A

needs to be measured at least every 24 hours and with every dressing change

23
Q

what are normal lactate levels for a patient

A

1-1.5 mmol/L

24
Q

what would lactate levels be if someone was critically ill and needed to be admitted to the ICU

A

lactate levels above 4 usually indicate the need for critical intervention

25
Q

What volume of air is considered significant if it were to enter a persons circulation

A

there is no exact number but anything greater than 50 is significant

26
Q

what factors determine the severity of an air embolism

A

Volume of air
rate that it enters
clients position at the time of entry

27
Q

what are the three types of CVAD occlusions

A

-Thrombotic occlusions
-Chemical occlusions
-Mechanical occlusions

28
Q

what are most chemical CVAD occlusions caused by

A

usually related to the formation medication or drug precipitate

29
Q

what are signs and symptoms of thrombotic occlusion

A

-pain and edema around IV site
-Engorged peripheral veins (from there being a backup of fluid)

30
Q

what is a mural catheter thrombus

A

when a clot starts to form around the catheter and attaches to the blood vessel wall

31
Q

what would indicate a intraluminal thrombosis

A

there would be increased resistance on both aspiration and infusion (since it has made the lumen of the catheter smaller)

32
Q

what would indicate a thrombus with a fibrin tail

A

infusion would be fine but aspiration may be difficult since the fibrin tail can get sucked back over the lumen of the catheter

33
Q

what would indicate that a fibrin sheath has formed over a catheter

A

the inability to aspirate or infuse since the catheter has been completely occluded by a thrombus

34
Q

What is catheter infiltration

A

when a non vesicant (non harmful) fluid leaks out of the vein into the surrounding soft tissue

35
Q

what is catheter extravasation

A

when a vesicant fluid leaks out of the vein into the surrounding tissue which can cause damage since it is a vesicant

36
Q

what would be some signs and symptoms of CVAD catheter migration

A

-edema in chest or neck during infusion
-client complains of gurgling sound in ear
-dysrhythmias

37
Q

can a RN diagnose and administer medication when a client starts to have an anaphylaxis reaction

A

YES

38
Q

what medication would an RN administer to a PT if they were having an anaphylaxis reaction

A

Dimenhydramine and epinephrine

39
Q

A client needs an IV line for 6 months of antibiotic therapy, which central line would be most appropriate?

A

PICC since they are used for more than one month but less than one year

40
Q

Does an IVAD need a heparin flush solution

A

yes to lock the line

41
Q

how many mL of heparin flush solution does an IVAD need to be locked

A

usually 5 mL

42
Q

if a client experiences an anaphylactic reaction to an antibiotic given IV through a VAD, the usual two drugs given are

A

Epinephrine and DiphenHYDRAMINE

43
Q

what is the purpose of placing a client on their left side in trendelenburg position

A

to move air into the right atrium and right ventricle where it can hopefully escape into the lungs

44
Q
A