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