Vascular - CLE Flashcards
1
Q
Indications for venepuncture
A
- blood specimen collection
- drug administration
- fluid replacement
2
Q
Safety precautions associated with venepuncture
A
- universal safety precautions - gloves, goggles, gowns
- check pathology slip, check patient
- proper sterilization needs to be performed
- use veins that do not have IV lines running through them, if that is the only option, use below the IV
- ensure patient comfort - pillows
- dispose of & remove needles as soon as is possible, recap needles
3
Q
Select an appropriate site for venepuncture
A
- basilic vein
- cephalic vein
- medial cubital
- avoid
- arm on side of mastectomy
- oedematous areas
- haematomas
- scarred areas
- arms with cannulas, fistulas, vascular grafts
- arm above IV
- dominant arm
4
Q
Select appropriate equipment for venepuncture
A
- vacutainer, syringe, butterfly
- tourniquet
- gloves, goggles
- kidney dish
- blood tubes
- needle
- alcohol wipe
- bluey
- gauze / cotton wool
- tape
5
Q
Perform venepuncture within a simulation environment
A
- client identification
- check name band against pathology request form
- client preparation
- privacy, positioning, ensure arm well supported
- apply tourniquet above cubital fossa on selected arm
- avoid pinching skin, shouldn’t be on for more than 1-2 minutes
- palpate for viable vein with tip of finger
- antecubital area most common
- basilic, cephalic, medial cubital
- site preparation
- alcohol wipe, 30 seconds, circular motion, leave till dry
- repalpate vein, stabilize vein (prevents rolling)
- enter vein with bevel facing up, needle at 15 degrees to the skin, stabilize needle while drawing blood
- release tourniquet
- remove needle
- apply direct pressure to the site, 3-5 minutes, longer if on anticoagulants, apply tape
- position patient comfortably, call bell, explanation
- label all blood tubes at bed side
- name & UR, DOB, ward, time, date, signature
6
Q
Indications for instertion of an intercostal catheter
A
- to remove air / fluid from pleural space & restore normal intrapleural pressure
- pneumothorax
- occurs when opening on the surface of the lung or in the chest wall, or both
- open - puncture through skin into lung, allowing atmospheric air into lung - penetrating trauma
- closed - chest wall intact, rupture of lung, congenital weakness, emphasema (eaten through lung)
- tension pneumothroax
- chest wall intact, air enters pleural space and has no way to leave, no vent to outside
- pressure builds and pushes to cause mediastinal shift - pushes heart & great vessels into unaffected side of chest, vena cava & right side of heart cannot accept venous return, no cardiac output, ICC needs to be inserted to re-establish cardiac output
- hemothorax
- blood in the pleural space
- occurs after surgery, traumatic injury, negative pressure within pleura is disrupted and lung collapses based upon how much blood is in the space
- pleural effusion
- fluid in the pleural space
- similar to hemothorax, except with transudate - clear fluid that collects when there are fluid shifts in the body, or exudate - cloudy fluid filled with cells & proteins
7
Q
Identify insertion sites of an ICC
A
- if air - in apex
- 2nd intercostal space in the midclavicular line or posteriorl
- if fluid - in base
- 4th or 5th intercostal space in mid axillary line
8
Q
Describe the three components of an UWSD
A
- first compartment
- collection chamber
- recieves fluid and air from the chest cavity, fluid stays in this chamber while air vents to second chamber
- second chamber
- water seal chamber
- contains about 2cm water which acts as a 1 way valve, incoming air enters and bubbles through the water, air leaves and enters suction chamber
- third chamber
- suction chamber
- applies controlled suction to the chest drainage system, strength of suction is determined by quantity of water in third chamber
9
Q
Describe potential complications of UWSD
A
- pain - as tube is external, movement may pull on tube and irritate sutures / skin
- infection - tube is external line into body, portal for infection
10
Q
Demonstrate setting up ICC insertion
A
- baseline observations, pulse oximetry used throughout procedure
- position dependent on insertion site
- explanation & reassurance
- analgesia
- emphasis need to stay still
- dressing, chest tube, chest drainage system tubing, chest drainage system
- post insertion
- observation of UWSD, secure chest tube, apply airtight dressing, immediate CXR, documentation of tube, time, location, respiratory status, volume of draining
11
Q
Discuss removal of ICC
A
- removal occurs when medical orders are made and when:
- drainage has diminished to nil <100mls within 24 hours
- drain has stopped bubbling indicating leak has resolved
- swinging of fluid is no longer visible in the water seal chamber
- lung is inflated on x-ray
- patient tolerates chest drain being clamped
- tube is removed at the end of inspiration, encouraged to breathe in and hold breath
- tube removed in one smooth movement
- pull purse string sutures if they are present
- using aseptic technique clean site
12
Q
Discuss nursing management of UWSD
A
- assessment should occur at least once per shift, preferably 1-2 hourly
- observe insertion site through dressing, checking for signs of inflammation or infection & that the dressing has remained airtight
- ensure UWSD is placed lower than the patient’s chest
- ensure suction is at prescribed level
- assess drainage - volume, colour, consistency
- any air leaks - bubbles in water seal chamber when patient exhales or coughs, lack of swinging (moves towards patient on inspiration and away on expiration)
- connections should all be kept secure, and tape used shouldn’t occlude visibility
13
Q
Discuss indications for a CVAD / PICC
A
- PICC
- used for prolonged period of time (up to 30 days)
- chemotherapy
- extended antibiotic therapy
- total parenteral therapy
- CVC
- form of longer term venous access (7-10 days)
- haemodynamic monitoring (CVP)
- administration of drugs likely to cause phlebitis
- administration of TPN
- lack of peripheral venous access
- secure IV access for inotropes & resuscitation
14
Q
Identify the different types of CVAD devices
A
- portacath
- surgically implanted port with silicone hub for needle insertion and attached catheter which extends along a large vein into the cavoatrial junction
- hickman catheter
- 2 insertion sites
- tunneled under skin to internal jugular vein
- commonly used for chemotherapy and dialysis
- CVC - single lumen or triple lumen
- single - drug administration
- triple - distal port - for CVP monitoring, largest lumen & closest to R atrium - medial port - TPN, other medications if TPN not running - proximal port - blood sampling, less contamination from infusions
15
Q
Identify the possible CVAD positions
A
- subclavian
- least rate of infection, considerable risk of infection during insertion
- internal jugular
- superficial access but most risk of complications
- femoral
- highest rate of infection but easy access with no immediate life threatening structures in the way
