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NRSG 202 > Week 7 - IV Push Meds and PICC Lines > Flashcards

Week 7 - IV Push Meds and PICC Lines Flashcards

1
Q

What skills/ activities must always be directly supervised by an RN?

A
  • wastage of all narcotics/ controlled substances
  • preparation/ administration of any high alert medication
  • PICC and CVAD flushing and aspirating for patency
  • IV push medications
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2
Q

What skills/ activities must be directly observed by a qualified health care provider?

A
  • medication
  • non-narcotic
  • non-high alert with existing IV infusion
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3
Q

What are restricted medications that students cannot give?

A

IV

  • adrenergic agonists and/ or isotopes
  • adrenergic antagonists
  • anti arrhythmic
  • radiocontrast agents
  • cardioplegic agents
  • chemotherapy
  • dialysis solution
  • neuromuscular blocking agents
  • oxytocin
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4
Q

Why can’t an LPN perform an IDC?

A

not within their scope of practice

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5
Q

What are the 10 rights for all medications?

A
  • right client
  • right time
  • right drug
  • right dose
  • right route
  • right reason
  • right assessment
  • right client teaching
  • right documentation
  • right elevation
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6
Q

What are the additional right for parental medications?

A
  • right dilution
  • right compatibility
  • right rate of administration
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7
Q

What are the additional rights for an infusion device (IV, pump, PCA, epidural, syringe pump)?

A
  • right infusion device
  • right protocol
  • right program settings
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8
Q

What does PICC stand for?

A

peripherally-inserted central catheter

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9
Q

What is a PICC?

A

central line inserted into a peripheral vein

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10
Q

Where is a PICC normally inserted?

A

cephalic, basilic or median cubital vein above the ACF

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11
Q

Where does the tip of a PICC rest?

A

in the lower portion of the distal superior vena cava

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12
Q

Who inserts a PICC? describe it

A
  • IV nurse inserts using ultrasound machine at bedside
  • takes 30-45mins
  • after inserted location of tip needs to be verified c CXR
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13
Q

When is a PICC used?

A

treatments expected to last between 2-6 months with a dwell time to a year

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14
Q

what are the different types of PICC lines?

A
  • valved or non-valved

- single, double or triple lumen

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15
Q

can a blood pressure be taken on the same arm of a PICC?

A

no

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16
Q

where should the tip of a CVAD catheter be located?

A

within the lower third of the superior vena cava

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17
Q

what do CVAD catheters positioned within the heart have?

A

increased risk of mortality

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18
Q

CVAD catheter tips positioned perpendicular to the vein wall have an increased risk of what?

A
  • vessel erosion
  • hydrothorax
  • hydromediastinum
  • tamponade
  • extravasation
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19
Q

When can a nurse use a CVAD?

A

when the tip position is confirmed

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20
Q

describe a valved PICC

A
  • venous access device with an internal valve

- device located at either proximal or distal end

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21
Q

what does the valve on a valved PICC allow?

A
  • infusion/ aspiration through the VAD
  • remains closed when not in use
  • prevents back flow/ provides safety mechanism
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22
Q

do you need to routinely clamp or heparinize a valved PICC?

A

no

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23
Q

What do you use to flush a valved PICC?

A

NS

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24
Q

How does a valve on a valved PICC work?

A
  1. no pressure
    - valve closed
  2. positive pressure
    - syringe opens valve outward for fluid admin
  3. negative pressure
    - opens valve inward for blood draw
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25
Q

describe a non-valved PICC

A
  • open ended
  • ## venous device without an internal valve/ device
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26
Q

what do non-valved VADs require?

A

heparin lock to keep patent

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27
Q

what does a non-valve PICC have?

A

clamp to prevent reflux or block flow of fluid contents/ blood

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28
Q

describe a power injectable PICC

A
  • purple central venous catheter that allows power injection of contrast media for scans
  • max rate of 5ml/ sec
  • all lumens 18 gauge
  • non-valved
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29
Q

what do power injectable PICC lines require?

A

heparin flush

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30
Q

What are the advantages of multi-lumen CVADs?

A
  • 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
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31
Q

what are some indications for a PICC?

A

administer

  • IV fluids/ blood products
  • medications
  • vesicants
  • irritants
  • solutions with extreme pH values
  • hypertonic solutions

obtain venous blood samples

32
Q

What is included in the role of the nurse caring for a client with a CVAD?

A
  • 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
33
Q

how often does a patency check need to be done in regards to PICC/ CVADS? why?

A
  • once every shift

- ensures line is correctly placed, patent, ready to use

34
Q

What should the nurse do if the PICC/ CVAD isn’t flushing?

A
  • notify IV team as soon as possible
35
Q

can you use a line that is not patent?

36
Q

How much do you need to use to flush a CVAD/ PICC before and after medications?

A

before - 10mL

after - 20mL

37
Q

How much do you need to use to flush a PVAD short-peripheral IV before and after medications?

A

before - 3mL

after - 10mL

38
Q

How much do you need to use to flush a PVAD midline/ extended dwell before and after medications?

A

before - 10mL

after - 20mL

39
Q

Why do we need to flush and aspirate central lines?

A

to prevent fibrin sheath from forming around catheter

40
Q

When assessing a PICC dressing what are you looking for?

A

dry and intact

41
Q

When assessing a PICC dressing what would indicate that it needs to be changed?

A
  • becomes damp
  • loosened
  • visibly soiled
  • moisture, drainage, blood present under dressing
42
Q

for PICC dressings how often does a transparent and gauze dressing need to be changed?

A

transparent - q7 days or prn

gauze - q2 days

43
Q

how often do PICC securements need to be changed?

A

q7 days or prn

44
Q

how often do needless caps for PICCs need to be changed?

A
  • q7 days
  • prn
  • when unable to clear blood from cap
45
Q

what do you use to clean the site of a PICC?

A

chlorhexidine

46
Q

if you have concerns after assessing a patient’s PICC dressing who do you report concerns to?

A
  • RN

- IV team if indicated

47
Q

when does the PICC external length need to be measured?

A

with every dressing change and prn if concerns

48
Q

How do you measure a PICC?

A
  • from the IV site to the thicker hub on line and document

- count each 1cm segment marking on line

49
Q

What do you do do after you’ve measured the PICCs external length? What if there’s a difference?

A
  • compare to previously documented length

- if over 2cm difference from initial measurement need to report to IV team ASAP

50
Q

What are some CVAD complications to assess for?

A
  • infection
  • occlusion
  • phlebitis
  • throbophlebitis
  • catheter migration
  • pulmonary embolism
  • air embolism
  • catheter embolism
  • pneumothorax
  • hemothorax
  • arrhythmia
51
Q

Some complications rarely occur in peripheral lines, but are much more common in central lines such as what?

A
  • air embolus
  • catheter embolus
  • pneumothorax
  • hemothorax
  • arrhythmias
52
Q

describe air embolisms in regards to PICC complications

A
  • mechanism of death/ injury depends on size/ where its lodged in body
53
Q

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?

A
  • MI
  • CVA
  • respiratory failure
54
Q

in regards to an air embolism to PICC complications what do you do if a venous air embolism occurs? What does this allow?

A
  • place client on left side and trendelenburg position

- encourages air bubble to move into right atrium preventing CV collapse

55
Q

in regards to an arterial embolism to PICC complication what position should you put the client in?

A

supine flat position

56
Q

What causes a pneumothorax or hemothorax PICC complication ?

A

accidental puncture of the pleura or lung during insertion

57
Q

What is the most common complication of Central venous catheter (CVC) insertions?

A

pneumothorax or hemothorax

58
Q

What causes an arrhythmia in regards to PICC complications?

A
  • CVAD advanced into right atrium

- risk of irritating heart

59
Q

How long can an IV medication solution bad hang for?

A

24hrs or less

60
Q

What should you never use when preparing parental medications?

A

pre-filled saline syringes

61
Q

after administering a parental medication what do you need to document?

A
  • assessment of all medication sites

- all responses to PRN medications

62
Q

What are key points for IV push medications?

A
  • 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
63
Q

What are the 8 steps to administer an undiluted or diluted IV push med through peripheral running IV?

A
  1. take MAR, medication, alcohol swab to bedside
  2. perform patient check c 2 patient identifiers/ explain procedure
  3. final check of med c MAR
  4. assess IV site, tube, bag, pump
  5. swab port closest to patient
  6. determine how much med to give q 15secs
  7. give med
  8. sign MAR
64
Q

What are the steps to administering an IV push medication into an INCOMPATIBLE solution through peripheral line?

A
  • 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
65
Q

What do you need to assess when giving an opioid?

A

baseline VS, sedation scale before administering medication

66
Q

At risk practices which potentially lead to adverse drug events include what? in regards to IV push medication safety

A
  • 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
67
Q

What are some complications specifically caused from IV push medication admin?

A
  • drug speed shock
  • chemical phlebitis
  • infiltration/ extravasation
68
Q

in regards to complications specifically caused from IV push medication admin, describe drug speed shock

A
  • systemic reaction caused by rapid injection of med into circulation
  • toxic levels of medication in plasma
69
Q

in regards to complications specifically caused from IV push medication admin, describe chemical phlebitis

A
  • inflammation of veins caused by medication infused through catheter
70
Q

in regards to complications specifically caused from IV push medication admin, describe infiltration/ extravasation

A

medication inadvertently injected into surrounding tissue of IV site

71
Q

Where do you document an IV medication given through a running IV or a SL?

A
  • MAR
  • VAD record
  • in/out record
72
Q

Where do you document morphine given as an IV push medication through a peripheral SL?

A
  • MAR
  • VAD
  • 24hr flow sheet
  • in/out record
73
Q

Where do you document an IV push medication that is greater than 10mL?

A
  • MAR
  • 24hr flow sheet
  • narrative notes
74
Q

Where do you document after giving an IV medication through a non-valved PICC that has been heparin-locked?

A
  • MAR
  • VAD
  • Narrative notes
  • 24hr flow sheet
75
Q

Where do you document after giving an IV medication through a valved PICC that has been saline locked?

A
  • MAR
  • In/out
  • VAD

NRSG 202 (11 decks)

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