VADs and Blood Admin Flashcards
What types of catheters are best for administering large volumes of fluid, PN, and other med ?
central vascular access devices (CVADs)
- long term use (chemo, PN)
What is a peripherally inserted central catheter (PICC) used for ?
peripherally inserted central catheter
- long term use (chemo, PN)
What is a peripheral catheter ?
for short term use
- after surgery or a procedure
How do you select a peripheral site ?
- avoid starting IV site on extremity with dialysis graft
- use distal veins prior to distal proximal veins
- use non dominant arm
- need order to use a site that isn’t the upper extremities
- do not select sites on mastectomy side, dialysis, paralyzed
- caution with hard veins, valves, skin bruising or other abnormalities, do not go below previous IV sites
What is phlebitis ?
inflammation of the lining of the vein
- red, painful, streak up vein, possible cord formation (hardening of vein)
What is the difference with infiltration or extravasation ?
- infiltration: leakage of a med that doesn’t irritate the skin
- extravasation: leakage of a med that irritates the skin
What are symptoms of infiltration or extravasation ?
cool, pallor to skin, could be painful, swollen
If infiltration is severe, what can you do to resolve it ?
apply a compress and elevate the affected limb
- aspirate fluid before removing catheter
- warm or cold compress depends on the facility
What is air embolism ?
obstruction caused by air entering the vein
What are symptoms of air embolism ?
- difficulty breathing
- wheezing
- cough
- decreased BP
- increased HR
- chest pain
What can air embolism lead to ?
shock, brain injury, MI, and death
What can do you to prevent air embolism ?
- prime all tubing carefully, check tubing, and IV sets for bubbles
- change bags before they run dry
- stop infusion, position pt with head down on their left side
How do you prevent infections at IV sites ?
- limit disconnecting tube
- teach pt to not handle IV site
- watch pt with SAGE/CHG bath daily
- use catheter stabilization device or tape IV site securely
What is the purpose of whole blood administrations ?
replacement in severe traumatic injuries
What is the purpose of packed RBC blood product ?
- sickle cell disease
- cancer
- anemia
- surgery
- blood loss
- trauma
What is the purpose of granulocyte blood products ?
neutropenia
What is the purpose of platelet blood products ?
decreased platelets from cancer
What is the purpose of plasma blood products ?
bleeding disorders, burns, shock
- in need of clotting factors
When administering blood what do you do ?
- determine if pt knows reason for blood transfusion
- do they have a recent type and screen in the EHR
- take baseline VS
What do you ask to see if pt knows the reason for blood transfusions ?
- have they had a previous blood transfusion
- have they had a previous blood transfusion reaction
- is the blood transfusion consent signed
How many RNs must verify blood transfusions ?
2
When administering blood, what can you hang with it ?
normal saline
- 0.9% NS only
What are signs of Anaphylactic shock with blood transfusions ?
- anxiety
- itching
- wheezing
- cyanosis
- shock
- rapid onset
What do you do for a pt with an anaphylactic shock with blood transfusions ?
stop treatment immediately and will likely need to give Epi
What causes a acute hemolytic reaction ?
incompatibility to antibodies causing RBC breakdown
What is febrile non-hemolytic ?
sensitization to specific blood components
- caused by antibodies against donor WBCs
What are some signs of febrile non-hemolytic ?
- chills
- fever
- HA
- flushing
What causes a mild allergic reaction to transfusion ?
sensitivity to plasma proteins
- S & S: flushing, itching, hives
What type of needle gauge is used for blood admins ?
prefer IV to be 20 gauge or larger
How long do you stay with the pt’s after and before blood admin ?
- stay with pt for 1st 15 min and monitor for side effects
- take VS after first 15 mins and end of transfusion
How long do we transfuse blood over ?
up to 4 hrs
- beyond 4 hrs there is a risk for bacterial contamination
For the first 15 mins of blood infusion, how long should you take ?
infuse blood slowly
What are some S & S of acute hemolytic reaction ?
- chills
- fever
- low back pain
- flushing
- tachycardia/pnea
- hypotension
- hemoglobinuria
- sudden oliguria (AKI)
- cardiac arrest
- death
What are some RN actions for transfusion reactions ?
- stop transfusion immediately (disconnect blood and saline tubing from IV- leave only the saline lock)
- keep IV line open with new saline and IV tubing
- maintain airway
- notify HCP
- remain with pt, observe S & S monitoring VS as often as every 5 mins
- save blood container and tubing
