week 3 CVAD complications Flashcards
catheter damage
what assessments do you do?
(
-q shift for pinholes, leaks, tears
assess for drainage from site after flushing
catheter damage prevention xx
- clamp properly
- avoid sharp objects near catheter
- use needlesless system device
- only 10 ml syringe!
- NEVER flush against resistance
your pt has holes, tears, leaks in thier CVAD
interventions?
-clamp!!! near insertion site and place sterile gauze!! over break or hole util repaired
- use only repair kit from manufacturer
- remove catheter (we would need order obviously)
occlusion (thrombos, fibrin sheath, fibrin tail precipitation, malposition)
assess
-insertion
-sutures
-blood return?
equipement?
-if using port, reaccess and verify non coring needle placement
-DISCOMFORT OR PAIN IN SHOULDER, NECK, ARM, EAR AT INSERTION SITE
-ASSESS FOR NECK OR SHOULDER EDEMA
prevention of thrombus xx
-dont flush w resistance
-secure
flush bet meds
-flush vigorously after viscous meds
-use pos P flush
-dont mid incompatible meds
-dont kink
occlusion interventions
reposition pt
- pt coughs and deep breaths
- raise pt arms overhead
- if ordered get venogram or give thrombolytics
- remove
- xray
- NEVER USE 1ML SYRINGE AS p EXCEEDS 200 PSI
dislodgement assessments
- daily length of catheter
- inform pt of possible catheter dislodgement
- identify edema at exit site or drainage
- palpate exit site and tunnel for coiling (skin may feel cordlike under the skin)
- assess for distended neck veins
dislodgement prevention xx
-loop and tape well
-use stablizationd evice and TSPDrsg
-dont pull
dont manipulate by hand
dislodgement intervention
- insert new catheter
- secure w catheter stabilization device
- teach pt not to manipulate catheter
CLABSI
infection and sepsis at exit site, tunnel, thrombus, port pocket
assess
- redness drainage, edema, tenderness at site
- infection
- labs
infection and sepsis intervention
- get blood cultures first from periph and CVD if ordered
- remove catheter
- replace catheter
- (other places said may cut tip of catheter for culture/s)
what is catheter pinch off syndrome
eg is compression of catheter bet clavicle and first rib)
catheter migration (length of catheter moved from origianla pos); pinch off syndrome; port separation; catheter fracture (internal) assessment
- gurgling sounds
- change in patency of catheter by eval change in flow rate, local irritation, swelling, occlusion, tenderness, pain, inability to aspirate fluid and or blood
- pain at site when flushed or symptoms of embolus
- xray
- edema of arm and hand on side of insertion?
- distended neck veins?
- inability to infuse fluids?
- assess length of catheter daily
all above are thigs you assess not necessarily youll see them all
catheter migration intervention
repos under fluoroscopy as ordered
- remove as ordered
- stop all fluid admin
prevent catheter migration
- avoid trauma
- avoid placement near site of local infect, scarring, skin disorder
what is cuff extrusion
tissue at esges of insertion site separate
skin erosion: eg mechanical loss of skin tissue, hematomas, cuff extrusion, scar tissue formation over port
what to assess
- assess for loss of viable tissue over septum site
- separation of exit side edge
- drainage at site
- redness
- edema, contusions
- is dacron cuff visible or tunneled catheter exposed
how prevent skin erosion
- maint nutrition
- avoid P or trauma
- rotate w each port access
- dont reinsert noncoring needle in same spot as previous insertion as it creates a permanent hole in septum
skin erosion intervention
- remove CVAD as ordered
- improve nutrition
- give appropriate skin care
infiltration or extravasation assessment
-erythema
-edema
spongy feeling
-swelling around IV site and at termination of catheter tip
-labored breathing
-aspiration of fluid and or blood
-complaints of pain w infusion of soln or meds eg burning
-assess for no free flow drip
infiltration/extravasation intervention
apply warm/cold compress according to the drug or protocol
- emotional support
- xray
- use antidote per protocol
- d/c IV fluids
- immed stop vesicant administration
- admin antidote or therapeutic meds to main tissue integrity according to protocol
how to assess for subcut emphysema
inspect and palpate skin around insertion site and along arm. this may reveal edema where air is located, and air may travel if skin is loose. palpation reveals a crackling sensation such as popping plastic bubble wrap
pneumothorax, hemothorax, air emboli, hydrothorax
ssessment
-assess for subcut emphysema
-chest pain
dyspnea, apnea, hypoxi, tachycardia, HoTN, nausea, confusion
prevention of pneumothorax, hemothorax, air emboli, hydrothorax
ssessment
- -use injection cap on distal end when not in use
- dont leave catheter open to air
- if has clamps make sure theyre engaged
interventions pneumothorax, hemothorax, air emboli, hydrothorax
ssessment
what to do if air emboli is suspected
- give 02 as nec
- elevate feet
- aspirate air, fluid
- if air emboli is suspected, PLACE PT ON LEFT SIDE WITH HEAD DOWN. remove catheter as ordered
- help w insertion of chest tube
incorrect placement assess
-cardiac dysrhythmias HoTN neck distension narrow pulse pressure retrograde flow of blood (fow of blood back into tubing usually cused by decreased pressure gradient between venous system and access device unit eg IV infusion, heparin lock)
incorrect placement prevention
- obtain xray film xm after placement
- reposition catheter as warranted
incorrect placement intervention
stop all fluid admin until placement is confirmed
- d/c catheter
- xray and ECG for CVADS and PICCS. admin support meds as nec
Infiltration
definition
Infiltration
• The unintentiojnal admin of a nonvesicant soln or med into surrounding tissue
med surgs suggestion of how infiltration might present
• characterized by edema around insertion site
o discomfort
o coolness
o significant dec in rate
how is infiltration usually easiy recog
• usually recog by bilateral comparison (look for swelling)
does backflow of blood into tubing prove anything
nope. doesnt means its still in vein
what is more reliable than backflow of blood fr det if peri0ph IV is in vein
• it is more reliable (than testing for backflow of blood) to put a tourniquet above infusion site and tighten it enough to restrict venous flow. If continues to drip despite obstruction of venous return then infiltration is present
what do if infiltration is suspected
• if infiltration is detected, the infusion should be stopped, IV d/c, sterile drsg applied to site after careful inspection to det the extent of infiltration
infiltration scale
- 0=no symptoms
- 1=skin blanched, edema less than 1 inch in any direction, cool to touch, with or without pain
- 2=skin blanched, edema 1-6 inches in any direction, cool to touch, with or without pain
- 3=skin blanched, translucent, gross edema greater than 6 inches in any direction, cool to touc, mild to moderate pain, possible numbness
- 4=skin blanched, translucent, skin tight, leaking, skin discoloured bruised, swollen, gross edema greater than 6 inches in any direction, deep pitting tissue edema, circ impairment, moderate to severe pain, infiltration of any amount of blood products, irritant, or vesicant
not sure if useful as our coursepack may contradict but when to use hot and cold for infiltration
- may apply warm compress to site if small volumes of noncaustic soln have infiltrated over long period or if the soln was isotonic w normal ph
- if infiltration was recent and soln was hypertonic or had inc ph, can apply cold compress to area
can you use same arm as there was infiltration for IV
yes but it must be proximal and in new site
extravasation is
• similar to infiltration w inadvertent admin of vesicant or med into surrounding tissue that can cause blistering, inflm, necrosis of tissue
extravasation how do you determine the extent of damage
• extent of amage determined by conc of med, quanitity that extravasated, the location of the infusion site, the tissue response, and the duration of the process of extravasation
extravasation interventions
• stop the infusion and notify dr, dr often says to give antidote, remove the cannula an apply warm compress to site
can you use same arm for IV after extravasation
no
what type of assessments to do after extravasation
thorough neurovascular assessments
extravasation on the phlebitis scale
• extravasation is rated as 4 on phlebitis scale
diff kinds of phlebitis
• can be chemical, mechanical, bacterial but often two or more occur at once
would a fast infusion rate result in chemical or mechanical phlebitis
chemical
phlebitis scale
• phlebitis scale
0-no symptoms
1-erythema at access site w or wout pain
2pain at access site w erythema and or edema
3-pain at access site w erythema and or edema. Streak formation. Venous cord.
4-pain at access site w erythema and or edema. Streak formation. Palpable venous cord >1 inch in length. Purulent drainage.
phlebitis tx
d/c the line
restart in another site
apply warm, moist compress to affected site
thrombophlebitis is
• The presence of a clot and inflm of the vein
s/s of thrombophlebitis
s local pain, rdness, warmth, swelling around insertion site or the path of the vein, immobility of the extremity d/t discomfort an swelling, sluggish flow rate, fever, malaise, leukocytosis
tx of thrombophlebitis
• tx: d/c IV old compress to dec blood flow and inc platelet aggregation and the a warm compress; elevate the extremity and restart the line in opposite extremity
thrombophlebitis has mnfts
if pt has s/s of thrombophlebitis don’t flush
should you flush pt IV if they have thrombophlebitis
• culture the catheter after cleaning the skin around the catheter with alcohol
thrombophlebitis prevention
• can be prevented with avoiding trauma to the vein at the time the line is inserted, observing site q1h, checking med additives for compatability
extravasation prevention
• prevention: monitor often, don’t insert in area of flexion, secure, use smallest cathteter possible
what can cause hematoma
• can happen when the opposite vein wall is punctured, needle slips out of vein, insufficient P is applied to the site after removal of the needle or cannula
s/s hematoma
• s/s=eccymosis, immed swelling at site, leak of blood
tx of heamtoma
• tx: removing the needle or cannula and applying light pressure w sterile, dry drsg; apply ice for 24hrs to avoid extension; elevating the extremity; assessing the extremity for any circulatory, neuro, motor dysfx and restart the line in other limb if nec
when does clotiing or obstr occur in periph IV
• may form d/t kinked line, slow rate, empty IV bag, fail to flush the line after intermittent med or soln admin
what to do and not do if clot in line
• if clot occurs d/c and start in new site. don’t irrigate or milk tubing don’t raise infusion rate or soln container and don’t aspirate the clot
prevention of clot in periph IV
• prevention: don’t let bag run dry, taping in tubing to prevent kinking and maint patency, maint adequate flow rate, flush line after intermittent med admin or soln admin
