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SKILLS Lab 3 > Week 8 - CVADs > Flashcards

Week 8 - CVADs Flashcards

1
Q

What are the diff. types of CVADs?

A
  1. non tunnelled - R. jugular/subclavian vein
  2. IVAD/Portacath - chemo drugs
  3. PICC - tip in Central venous system
  4. Tunnelled - long term access - tunnels under the skin
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2
Q

When are CVADs indicated?

A
  1. Long term IV access - 3+ weeks to years
  2. Parenteral nutrition - vesicant
  3. chemo/vesicant/irritating solutions
  4. blood products
  5. Antibiotics - longer therapy
  6. IV meds/solutions when IV access is limited
  7. central venous pressure monitoring
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3
Q

Where does the blue line end up on the tip?

A

Proximal

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4
Q

Where does the yellow line end up on the tip?

A

Distal

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5
Q

Where does the red line end up on the tip?

A

Medial

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6
Q

What do open-ended tips require to be flushed with?

A

Saline flush & heparin
Broviac and Hickman - tunneled

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7
Q

What do valved tips require to be flushed with?

A

NS
Groshong - PICCs

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8
Q

With open ended tips, what are we worried about?

A
  1. clotting d/t back flow
  2. air getting in
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9
Q

What are the advantages of the PICC?

A
  1. easy to insert at bedside - don’t need general anasthetic
  2. Nurses can do it with certification
  3. long term antibiotics (6-8 wks)
  4. TPN, chemo
  5. Long term
  6. Single and double lumen
  7. Valved - no heparin needed
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10
Q

What are the disadvantages to PICCs?

A
  1. no vigerous movement
  2. no swimming - maybe bathing/showering allowed
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11
Q

How many lumens are tunneled CVAD?

A

1-3 lumens

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12
Q

How long do non-tunneled CVADs stay in?

A

Up to 1 week in hospital

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13
Q

How many lumens does a non-tunelled have?

A

1-4 lumens

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14
Q

What are the risks of non-tunneled CVAD?

A
  1. risk for infection is greater
  2. venipuncture above the lungs = risk for pneumothorax
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15
Q

What type of needle is used to access the IVAD?

A

Huber (non-barbed, non-coring)

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16
Q

Where are IVADs found on the body?

A
  1. Chest
  2. Abdomen
  3. Arm
  4. Leg
17
Q

What do we use if accessing an IVAD/port-a-cath is painful?

A

Emla cream

18
Q

What is a VAS CATH used for?

A

hemodialysis
- in an emergency they can be accessed for something other than dialysis

19
Q

What are the complications with CVADS?

A
  1. Hemorrhage
  2. Hemothorax/pneumothorax
  3. Surgical emphysema
  4. Local cellulitis
  5. Local hematoma
  6. Air embolus - medical emergency
  7. Dysrhythmias - irritate the heart
  8. Malposition - wrong location (verify with xray/ultrasound)
20
Q

What are the complications of CVAD use?

A
  1. Phlebitis (angry vein) - less common than IV
  2. Infiltration/extravasation - measure length
  3. Infection
  4. Air embolism
  5. Thrombosis
21
Q

What do we do if a CVAD line is pulled out?

A
  1. cover site with air-occlusive dressing
  2. Patient on left side
  3. Trendelenburg position
  4. stay with patient and get colleague to contact doctor
22
Q

What are the signs of air embolism relating to CVAD complication?

A
  1. Dyspnea
  2. Chest pain
  3. Tachycardia
  4. Hypotension
  5. Anxiety
  6. Nausea
  7. Dizziness
  8. Confusion
23
Q

Why do we put patients in trendelenburg position with air embolism?

A

To trap the air in the bottom of the right ventricle (so it doesn’t go to the lungs)

24
Q

What is the typical amount of saline and heparin used when accessing a subclavian (non-valved) CVAD?

A

10-20 NS flush
200 units heparin lock

25
Q

What is the typical amount of saline & heparin used when accessing IVAD (non-valved?

A

10-20mL NS flush
500 units heparin

26
Q

Should we aspirate back on our lines that are hep locked?

A

hospital policy
it’s not a bad procedure b/c we don’t know what is sitting in that line from the previous nurse/access

27
Q

What do we need to be careful with heparin?

A

Pre-filled syringes
- 1000/ml- IVADS
- 100/ml - other CVADs

28
Q

What can a patient do if there’s no blood return from a CVAD?

A
  1. change patient position
  2. Deep breath
  3. cough
  4. Raise arms over head
29
Q

How often do we change caps/dressings?

A

usually 7 days or PRN

SKILLS Lab 3 (6 decks)

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