Week 7 - IV Push Meds and PICC Lines Flashcards
What skills/ activities must always be directly supervised by an RN?
- wastage of all narcotics/ controlled substances
- preparation/ administration of any high alert medication
- PICC and CVAD flushing and aspirating for patency
- IV push medications
What skills/ activities must be directly observed by a qualified health care provider?
- medication
- non-narcotic
- non-high alert with existing IV infusion
What are restricted medications that students cannot give?
IV
- adrenergic agonists and/ or isotopes
- adrenergic antagonists
- anti arrhythmic
- radiocontrast agents
- cardioplegic agents
- chemotherapy
- dialysis solution
- neuromuscular blocking agents
- oxytocin
Why can’t an LPN perform an IDC?
not within their scope of practice
What are the 10 rights for all medications?
- right client
- right time
- right drug
- right dose
- right route
- right reason
- right assessment
- right client teaching
- right documentation
- right elevation
What are the additional right for parental medications?
- right dilution
- right compatibility
- right rate of administration
What are the additional rights for an infusion device (IV, pump, PCA, epidural, syringe pump)?
- right infusion device
- right protocol
- right program settings
What does PICC stand for?
peripherally-inserted central catheter
What is a PICC?
central line inserted into a peripheral vein
Where is a PICC normally inserted?
cephalic, basilic or median cubital vein above the ACF
Where does the tip of a PICC rest?
in the lower portion of the distal superior vena cava
Who inserts a PICC? describe it
- IV nurse inserts using ultrasound machine at bedside
- takes 30-45mins
- after inserted location of tip needs to be verified c CXR
When is a PICC used?
treatments expected to last between 2-6 months with a dwell time to a year
what are the different types of PICC lines?
- valved or non-valved
- single, double or triple lumen
can a blood pressure be taken on the same arm of a PICC?
no
where should the tip of a CVAD catheter be located?
within the lower third of the superior vena cava
what do CVAD catheters positioned within the heart have?
increased risk of mortality
CVAD catheter tips positioned perpendicular to the vein wall have an increased risk of what?
- vessel erosion
- hydrothorax
- hydromediastinum
- tamponade
- extravasation
When can a nurse use a CVAD?
when the tip position is confirmed
describe a valved PICC
- venous access device with an internal valve
- device located at either proximal or distal end
what does the valve on a valved PICC allow?
- infusion/ aspiration through the VAD
- remains closed when not in use
- prevents back flow/ provides safety mechanism
do you need to routinely clamp or heparinize a valved PICC?
no
What do you use to flush a valved PICC?
NS
How does a valve on a valved PICC work?
- no pressure
- valve closed - positive pressure
- syringe opens valve outward for fluid admin - negative pressure
- opens valve inward for blood draw
describe a non-valved PICC
- open ended
- ## venous device without an internal valve/ device
what do non-valved VADs require?
heparin lock to keep patent
what does a non-valve PICC have?
clamp to prevent reflux or block flow of fluid contents/ blood
describe a power injectable PICC
- purple central venous catheter that allows power injection of contrast media for scans
- max rate of 5ml/ sec
- all lumens 18 gauge
- non-valved
what do power injectable PICC lines require?
heparin flush
What are the advantages of multi-lumen CVADs?
- more than 1 lumen, at least one lumen is a different gauge
- administer multiple medications/ treatments at same time
- administer multiple incompatible medications at same time
what are some indications for a PICC?
administer
- IV fluids/ blood products
- medications
- vesicants
- irritants
- solutions with extreme pH values
- hypertonic solutions
obtain venous blood samples
What is included in the role of the nurse caring for a client with a CVAD?
- ensure asepsis with all central lines/ venous access ports
- assess site
- ensure patency
- perform flushes
- lock the line after use c saline and heparin
- assess PICC dressing
- check external length
- assess for CVAD complications
how often does a patency check need to be done in regards to PICC/ CVADS? why?
- once every shift
- ensures line is correctly placed, patent, ready to use
What should the nurse do if the PICC/ CVAD isn’t flushing?
- notify IV team as soon as possible
can you use a line that is not patent?
no
How much do you need to use to flush a CVAD/ PICC before and after medications?
before - 10mL
after - 20mL
How much do you need to use to flush a PVAD short-peripheral IV before and after medications?
before - 3mL
after - 10mL
How much do you need to use to flush a PVAD midline/ extended dwell before and after medications?
before - 10mL
after - 20mL
Why do we need to flush and aspirate central lines?
to prevent fibrin sheath from forming around catheter
When assessing a PICC dressing what are you looking for?
dry and intact
When assessing a PICC dressing what would indicate that it needs to be changed?
- becomes damp
- loosened
- visibly soiled
- moisture, drainage, blood present under dressing
for PICC dressings how often does a transparent and gauze dressing need to be changed?
transparent - q7 days or prn
gauze - q2 days
how often do PICC securements need to be changed?
q7 days or prn
how often do needless caps for PICCs need to be changed?
- q7 days
- prn
- when unable to clear blood from cap
what do you use to clean the site of a PICC?
chlorhexidine
if you have concerns after assessing a patient’s PICC dressing who do you report concerns to?
- RN
- IV team if indicated
when does the PICC external length need to be measured?
with every dressing change and prn if concerns
How do you measure a PICC?
- from the IV site to the thicker hub on line and document
- count each 1cm segment marking on line
What do you do do after you’ve measured the PICCs external length? What if there’s a difference?
- compare to previously documented length
- if over 2cm difference from initial measurement need to report to IV team ASAP
What are some CVAD complications to assess for?
- infection
- occlusion
- phlebitis
- throbophlebitis
- catheter migration
- pulmonary embolism
- air embolism
- catheter embolism
- pneumothorax
- hemothorax
- arrhythmia
Some complications rarely occur in peripheral lines, but are much more common in central lines such as what?
- air embolus
- catheter embolus
- pneumothorax
- hemothorax
- arrhythmias
describe air embolisms in regards to PICC complications
- mechanism of death/ injury depends on size/ where its lodged in body
in regards to an air embolism in regards to PICC complications what can an air bubble cause if it travels to the brain, heart or lungs?
- MI
- CVA
- respiratory failure
in regards to an air embolism to PICC complications what do you do if a venous air embolism occurs? What does this allow?
- place client on left side and trendelenburg position
- encourages air bubble to move into right atrium preventing CV collapse
in regards to an arterial embolism to PICC complication what position should you put the client in?
supine flat position
What causes a pneumothorax or hemothorax PICC complication ?
accidental puncture of the pleura or lung during insertion
What is the most common complication of Central venous catheter (CVC) insertions?
pneumothorax or hemothorax
What causes an arrhythmia in regards to PICC complications?
- CVAD advanced into right atrium
- risk of irritating heart
How long can an IV medication solution bad hang for?
24hrs or less
What should you never use when preparing parental medications?
pre-filled saline syringes
after administering a parental medication what do you need to document?
- assessment of all medication sites
- all responses to PRN medications
What are key points for IV push medications?
- receive doctor order
- determine how drug is given
- if drug given direct IV does it need to be diluted or not
- figure out rate of administration
- check compatibility with other drugs
What are the 8 steps to administer an undiluted or diluted IV push med through peripheral running IV?
- take MAR, medication, alcohol swab to bedside
- perform patient check c 2 patient identifiers/ explain procedure
- final check of med c MAR
- assess IV site, tube, bag, pump
- swab port closest to patient
- determine how much med to give q 15secs
- give med
- sign MAR
What are the steps to administering an IV push medication into an INCOMPATIBLE solution through peripheral line?
- stop IV pump
- medication not diluted during admin
- IV line clamped for entire procedure
- IV line port cleaned c alcohol swab and flushed before med c 10mL NS
- port cleaned c alcohol swab and med given at correct rate through line
- port cleaned with alcohol swab and flush c 10mL NS
- everything unclamped pump restarted
What do you need to assess when giving an opioid?
baseline VS, sedation scale before administering medication
At risk practices which potentially lead to adverse drug events include what? in regards to IV push medication safety
- unlabeled syringes
- mislabeled syringes
- syringe to syringe transfer
- unnecessary dilution
- use of saline flush syringes to dilute IV meds
- high nurse workloads/ high patient volume
What are some complications specifically caused from IV push medication admin?
- drug speed shock
- chemical phlebitis
- infiltration/ extravasation
in regards to complications specifically caused from IV push medication admin, describe drug speed shock
- systemic reaction caused by rapid injection of med into circulation
- toxic levels of medication in plasma
in regards to complications specifically caused from IV push medication admin, describe chemical phlebitis
- inflammation of veins caused by medication infused through catheter
in regards to complications specifically caused from IV push medication admin, describe infiltration/ extravasation
medication inadvertently injected into surrounding tissue of IV site
Where do you document an IV medication given through a running IV or a SL?
- MAR
- VAD record
- in/out record
Where do you document morphine given as an IV push medication through a peripheral SL?
- MAR
- VAD
- 24hr flow sheet
- in/out record
Where do you document an IV push medication that is greater than 10mL?
- MAR
- 24hr flow sheet
- narrative notes
Where do you document after giving an IV medication through a non-valved PICC that has been heparin-locked?
- MAR
- VAD
- Narrative notes
- 24hr flow sheet
Where do you document after giving an IV medication through a valved PICC that has been saline locked?
- MAR
- In/out
- VAD
