Week 7: IV Push Medications and PICC Lines Flashcards
All IV meds
Considered HAM
Additional Pareneteral medication rights
Right Dilution
Right Compatibility
Right rate of administration
Additional rights for an infusion pump
Right infusion device
right protocol
right program settings
What is a PICC
A central line inserted into a peripheral vein
Where is a PICC usually inserted
into cephalic, basilic or median cubital vein above the antecubital fossa
Where does the PICC tip rest
lower portion of the distal superior vena cava
How is a PICC inserted
usuing a ultrasound machine at the bedside, usually 30-45 minutes
After a PICC is inserted
location needs to be verified with a chest X ray
what duration is usually when a PICC is used
for treatments expected to last more than 1 months but less than a year
What should never occur on an arm with a PICC
Blood pressure should not be taken
Catheters positioned within the heart
have an increase risk of mortality
Catheteres positioned perpendicular to the vein wall
have an increased risk of vessel erosion, hydrothorax, hydromediatinum, tamponade, and extraversion
Nurses should never use a CVAD…
until the tip position is confirmed
Valved PICC
allows infusion and aspiration through the VAD but prevents back flow when not in use
Non Valved PICC
has a clamp to prevents reflux or back flow
What do non valved PICCs require
a heparin lock to keep patent
What is a PICC Power Injectable
a purple central venous catheter that allows power injection of contrast media for scans
what is a power injectables gauge and max rate
Max rate: 5mL/sec
Gauge: 18
what do power injectables often require
heparin flush
Advantages of multi-lumen CVADs
may administer multiple medications at the same time
may administer multiple incompatible medications at the same time
PICC Indications
IV fluids/blood products
medications
vesicants
irritants
solutions with extreme pH values
hypertonic solutions
obtain venous blood samples
Role of nurse with CVAD care
- ensure asepsis
- assess site
- ensure patency
- assess PICC dressing
- Check external length
- assess for CVAD complications
Perfoming flush check steps
1.check for resistance on aspiration, ability to withdraw blood and ability to infuse fluids without resistance
2. 3-5mL push pause
3. med
4. 10mL after (lock with saline/heparin)
How often is a patency check done?
once every shift
How often is transparent gauze changed?
Q7 days and PRN
How often is a securement device changed
Q7 days and PRN
How often is a needless cap changed
Q7 days and PRN
what is used to clean a PICC site
chlorhexidine
How often does the external length of the catheter need to be measured?
every dressing change and PRN
when does the measurement of a catheter need to be reported?
if over 2cm difference from initial measurement
What are potential CVAD complications
infection
occlusions
phlebitis
catheter migration
pulmonary embolism
air embolism
catheter embolism
pneumothorax/hemothorax
arrhythmia
Some complications rare in peripheral lines but common in central like:
Air embolus
catheter embolus
pneumothorax/hemothorax
arrhythmias
Air embolism
when air bubble lodges in the body
interventions for an air embolism
place client on left side in trendelenburg position
If an air bubble travels to brain, heart or lungs
can cause an MI, CVA, or resp failure
Pneumothorax/hemothorax
caused by accidental puncture of the pleura or lung during insertion
Arrhythmia
when CVAD is advanced into the right atrium and it irritates the heart
gives irregular beats you hear on auscultation
How long should IV medication bags be hung
24 hours max
What syringe is used to flush peripheral IV
3-12 mL
What syringe is used to flush PICC/CVAD
10mL or greater
What do abx meds need prior to administration?
Be warmed after coming out of fridge
IV push through PVAD Steps
- Take MAR and med to bedside + patient identify
- Assess IV site, tubing,pump
- Determine med math
- Stop pip and close roller clamp
- swab lowest port and attach saline
- assess for patency and flush 3-5mL
- swab port and attach med
- swab port and flush with 10mL
- open roller clamp and restart pump
if a med is not listed under compatibility with another med what do you assume
assume it is incompatible (its probably never been tested together before)
Steps to give IV push with incompatible solution
- Take MAR and med and perform check
- Assess site, tubing, bag, pump
- med math
- stop pump and close roller clamp
- swab lowest port and attach NS
- pinch line above port
- aspirate and flush with 10mL
- give med
- flush with another 10 while line is pinched
- release pinch, remove syringe, start pump again
Drawing up morphine with diluent in syringe method
- swab NS vial
- inject air and draw up 9mL NS
- draw up 1mL of morphine
- waste morphine
- have RN IDC
- label with med name, dose, volume, route, rate, and patient
Catheter occlusion causes
clamped or kinked
tip against wall of vessel
thrombosis
precipitate build in lumen
Signs and symptoms of catheter occlusion
sluggish infusion or aspiration
unable to infuse or aspirate