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NRSG 202 > Week 9 - CVAD > Flashcards

Week 9 - CVAD Flashcards

1
Q

What are the different types of CVADS?

A
  • PICC
  • non-tunnelled CVADS
  • tunnelled CVAD
  • IVAD
  • hemodialysis catheter
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2
Q

How long can a PICC be used for treatment?

A

more than 1 month but less than 1 year

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3
Q

Where are PICC lines inserted in the periphery?

A
  • cephalic
  • basilic
  • medin cubital vein
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4
Q

where does the tip of a PICC rest?

A
  • lower portion of the distal superior vena cava
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5
Q

how many lumens can a PICC be?

A
  • single lumen
  • double lumen
  • triple lumen
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6
Q

Where are the 3 places a non-tunnelled CVADS can be placed?

A
  • jugular
  • subclavian
  • femoral (not common)
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7
Q

when are non-tunnelled CVADS used?

A

short term/ emergent therapy

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8
Q

how long can a non-tunnelled CVADS be left in place? why?

A

7 days to a month b/c of increased risk of infection

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9
Q

where is a non-tunnelled CVADS placed?

A
  • internal jugular
  • external jugular
  • subclavian vein
  • rarely in femoral vein
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10
Q

Who inserts a non-tunnelled CVADS? What needs to be done after?

A
  • surgically sutured by a physician

- placement needs to be verified by CXR

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11
Q

what lumens can a non-tunnelled CVADS be?

A
  • single lumen
  • double lumen
  • triple lumen
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12
Q

What do non-tunnelled CVADS require?

A
  • sterile dressing

- heparin flush solution to maintain patency

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13
Q

where is a percutaneous CVAD inserted?

A

internal jugular or subclavian vein

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14
Q

When are tunnelled CVADS used?

A
  • long term intermittent
  • continuous access
  • treatments expected to last more than 1 year and long term
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15
Q

where is a tunnelled CVADS inserted?

A
  • subclavian or internal jugular vein
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16
Q

in regards to a tunnelled CVADS where is the proximal end placed?

A
  • tunnelled subcutaneously from the insertion site (10-15cm)
  • brought out through skin at an exit site
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17
Q

What does the tunnelled portion of a tunnelled CVADS have?

A

Dacron cuff

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18
Q

where is a dragon cuff placed in regards to a tunnelled CVADS?

A

under the skin just above the exit site

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19
Q

what will happen to the dacron cuff in 3-4 weeks in regards to a tunnelled CVADS?

A
  • granulation tissue will grow onto cuff
  • creates a seal
  • seal helps keep catheter from slipping out/ acts like a barrier to infection
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20
Q

how is a tunnelled CVADS inserted?

A

surgically in OR or in medical imaging under fluoroscopy

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21
Q

what lumen size can a tunnelled CVADS be?

A
  • single lumen
  • double lumen
  • triple lumen
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22
Q

what does a tunnelled CVADS require?

A

heparin flush solution to maintain patency

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23
Q

is a dressing required for a tunnelled CVADS?

A
  • required until site is healed

- no dressing needed at home

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24
Q

when is an IVAD used?

A
  • long term IV therapy

- treatments expected to last more than 1 year

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25
Q

what does the port of an IVAD include?

A
  • reservoir
  • hallow metal disk with a self sealing membrane
  • catheter
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26
Q

where is the distal end of an IVAD normally placed?

A
  • in the distal third of the superior vena cava
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27
Q

how is an IVAD placed?

A

surgically by vascular surgeon

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28
Q

where is an IVAD surgically placed?

A
  • on the upper anterior chest

- line is tunnelled to the vein and secured with sutures

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29
Q

does an IVAD have an increased risk for infection?

A

no, it has a decreased risk

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30
Q

does an IVAD require a dressing?

A
  • no dressing required when not being used

- if being used needs aseptic dressing over needle, site, tubing

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31
Q

what is used to access the port on an IVAD?

A
  • huber needle with attached extension tubing
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32
Q

can a student access/ de-access an IVAD?

A

no, you need further education to do this

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33
Q

When assessing an IVAD what are you looking for?

A
  • dislodging of Catheter tip

- signs of dislodged port

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34
Q

how often does an IVAD need to be flushed? What do you use to flush it?

A
  • flushed at least every 8 weeks when not in use

- heparin flush

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35
Q

what are the signs of a dislodging catheter tip in regards to an IVAD?

A
  • neck or ear pain
  • an affected side
  • gurgling sounds
  • palpitations
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36
Q

what are the signs of a dislodging port in regards to an IVAD?

A
  • free movement of port
  • swelling
  • difficulty accessing port
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37
Q

When is a hemodialysis catheter used?

A

temporary access needed for hemodialysis

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38
Q

Where is a hemodialysis catheter inserted?

A

internal jugular or subclavian vein then into superior vena cava

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39
Q

what are the 2 types of tunnelled hemodialysis catheters?

A
  • uncuffed

- cuffed

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40
Q

when would you use an uncuffed tunnelled hemodialysis catheter?

A

in an emergency or treatment is less than 3 months

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41
Q

when would you use a cuffed tunnelled hemodialysis catheter?

A

used if treatment is longer than 3 months

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42
Q

who inserts a hemodialysis catheter?

A

nephrologist, surgeon or radiologist in x-ray department or operating room

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43
Q

now is a hemodialysis catheter kept in place?

A

by a stitch on the skin

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44
Q

How is a hemodialysis catheter kept in place if used permanently?

A

stitch may be removed once catheter is firmly in place

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45
Q

what are indications for a CVAD?

A
  1. administer:
    - IV fluids/ blood products
    - medications/ irritants
    - vesicants
    - solutions c extreme pH values
    - hypertonic solutions
  2. obtain venous blood samples
  3. monitor central venous pressure
  4. provide access for:
    - pulmonary artery catheters
    - transvenous pacemaker
    - hemodialysis
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46
Q

What is used to administer total parenteral nutrition?

A

CVAD

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47
Q

What is used to administer PPN?

A

peripheral line

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48
Q

in regards to a CVAD what dis needed to administer TPN?

A
  • in line filter

- dedicated line

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49
Q

What port is used on a multi-lumen CVAD for TPN?

A

white port

50
Q

Who prepares TPN solutions?

A

pharmacy daily

51
Q

What does CVP stand for?

A

Central Venous Pressure

52
Q

CVP is the pressure measured in what?

A

vena cava near the right atrium

53
Q

Where is a CVAD typically placed?

A

subclavian or jugular vein

54
Q

What is the normal range for a CVP?

A

3-8cm H2O or 2-6mmHg

55
Q

what are the indications for a CVP?

A
  • hypotension refractory to fluid resuscitation

- severe sepsis

56
Q

describe hemodynamic monitoring

A

catheter inserted into pulmonary artery

57
Q

What does hemodynamic monitoring include?

A
  • measures of heart rate
  • arterial pressure
  • cardiac filling pressures/ volumes
  • cardiac output
  • mixed venous oxygen saturation
58
Q

what is a transvenous pacemaker

A
  • potentially like saving intervention used primarily to correct profound bradycardia
59
Q

in regards to transvenous pacemakers what can they be used for?

A

treat symptomatic bradycardia that doesn’t respond to transcutaneous pacing or to drug therapy

60
Q

where is a transvenous pacemaker placed?

A

pacing electrode threaded through vein into right atrium, right ventricle or both

61
Q

what do you do if there is residual blood left in the cap after flushing a CVAD?

A

perform a needless cap change

62
Q

what supplies do you need to perform a needless cap change?

A
  • new sterile needless cap
  • alcohol wipes
  • 10mL flush syringe
63
Q

What are the steps in forming a needlessness cap change?

A
  • prep needleless cap keeping sterile
  • attach NS/ prime line
  • scrub hub around old needleless cap end
  • attach to port c alcohol for 30sec
  • request client turn head away from line
  • ensure line clamped
  • remove old needleless cap/ replace c primed new one
  • patency check/ flush/ restart infusion
64
Q

How do you know if a line is occluded?

A
  • no blood able to be aspirated
  • sluggish blood return
  • resistance to flushing
  • fluids will not infuse via gravity
  • frequent occlusion alarms
  • infiltration/ extravasation
  • swelling
65
Q

How often do you need to flush a PVAD that is not in use?

A

Q24hrs

66
Q

how often do you need to flush any CVAD that is not in use?

A

once a week

67
Q

how often do you need to flush an IVAD that is not in use?

A

assess patience and flush q1-3 months

68
Q

When changing a CVAD dressing what do you assess for?

A
  • signs/ symptoms of infection/ complications

- external length marked on catheter

69
Q

for a CVAD dressing if there is drainage, blood or moisture under the dressing how often does it need to be changed?

A

Q7days and PRN

70
Q

for a CVAD dressing if there is drainage, blood or moisture under the dressing and gauze is placed over site how often does it need to be changed?

A

change 48hrs of placement of gauze

71
Q

What are potential CVAD complications that could happen during insertion?

A
  • arrhythmia
  • arterial puncture
  • pneumothorax
  • hemothorax
  • hydrothorax
  • injury to brachial nerve plexus
  • cardiac perforation
  • central venous perforation
  • catheter migration/ malposition
  • intolerance reaction
72
Q

What does hydrothorax means?

A

infiltration of IV fluids in the pleural space

73
Q

What are potential CVAD complications that could happen after insertion?

A
  • pulmonary embolism
  • phlebitis
  • infection
  • total or partial occlusion
  • venous thrombosis
  • extravastion
  • infiltration
  • catheter fracture
74
Q

what is a venous thrombosis?

A
  • blood clot between the catheter and the vein or an intraluminal clot
75
Q

What is one complication that can occur during both insertion and post insertion of a CVAD?

A

air embolism

76
Q

What are infusion related complications in regard to a CVAD?

A
  • circulatory overload
  • speed shock
  • allergic reactions
  • particulate matter
77
Q

What are signs and symptoms of a local catheter related infection/ sepsis?

A
  • redness
  • tenderness
  • purulent drainage
  • edema at the insertion site
78
Q

What are signs and symptoms of a systemic catheter related infection/ sepsis?

A
  • fever
  • chills
  • malaise
79
Q

What is the diagnosis used to determine catheter related infections/ sepsis?

A
  • increased temp
  • increased HR
  • increased RR
  • decreased BP
  • altered LOC
  • abnormal lab results
80
Q

what is the treatment for local catheter related infection/ sepsis?

A
  • warm moist compresses
  • culture of drainage from site
  • catheter removal if indicated
81
Q

what is the treatment for systemic catheter related infection/ sepsis?

A
  • IV fluids
  • antibiotics
  • sepsis protocol
  • catheter removal if indicated
82
Q

what are the guidelines for preventing CVAD infections?

A
  • hand hygiene
  • clean needleless cap
  • palate insertion site
  • inspect insertion site
  • remove IV when no longer needed
83
Q

what 2 conditions must be simultaneously present for air to enter the vascular system?

A
  • pressure gradient between vascular space/ atmospheric air

- direct line of access to the blood vessel

84
Q

what does the severity of an air embolism depend on?

A
  • volume of air that enters the vessel
  • rate of entry
  • client’s position at the time of entry
85
Q

what are client dependent considerations in regards to air embolisms?

A
  • age
  • size
  • existing disease process
86
Q

there is not an exact volume of air that is significant but in general what amount is considered potentially lethal for air embolisms?

A

greater than 50mL

87
Q

in regards to air embolisms the rate of entry affects what?

A

potential/ severity of resulting morbidity/ mortality

88
Q

what are signs and symptoms of an air embolism?

A
  • sudden onset of dyspnea
  • continued coughing
  • breathlessness
    altered mental status
    shoulder/ chest pain
  • lightheadedness
  • hypotension
    jugular vein distension
  • feeling of impaired doom
89
Q

what is the treatment for an air embolism?

A
  • close/ clamp existing catheter
  • occlude puncture site of catheter that has been removed
  • trandelenburg left lateral position
  • apply O2
  • notify MRP
90
Q

What are the different types of CVAD occlusions?

A
  • thrombotic occlusion
  • chemical occlusion
  • mechanical occlusion
91
Q

what percent of occlusions are thrombotic occlusions responsible for?

A

58%

92
Q

what percent of occlusions are chemical occlusions responsible for?

A

42%

93
Q

describe a thrombotic occlusion

A

thrombus that attached to CVAD and has also adhered to vessel wall

94
Q

what are the signs and symptoms of a thrombotic occlusion?

A

pain, edema and engorged peripheral veins in:

  • neck
  • shoulder
  • chest
95
Q

what is the treatment for a thrombotic occlusion?

A
  • thrombolysis therapy

- systemic anti-coagulation with/ without CVAD removal

96
Q

What are the different types of catheter thrombosis?

A
  • intraluminal clot
  • fibrin tail
  • mural thrombus
  • fibrin sheath
97
Q

describe an intraluminal clot in regards to the different types of catheter thrombosis?

A
  • resistance upon aspiration

- decreased ability to infuse fluids

98
Q

describe an fibrin tail in regards to the different types of catheter thrombosis

A

resistance upon aspiration as tail gets sucked back over opening when blood aspirations attempted
- no resistance when flushing

99
Q

describe an mural thrombus in regards to the different types of catheter thrombosis

A
  • depending on location may/may not be symptomatic upon syringe assessment
  • result in partial/ complete occlusion of vein
100
Q

what are signs and symptoms of a mural thrombus?

A
  • swelling
  • pain
  • tenderness
  • engorged vessels
101
Q

describe a fibrin sheath in regards to the different types of catheter thrombosis

A
  • inability to aspirate
  • difficult to withdraw blood
  • resistance/ inability to infuse fluids
  • creates sock over end of catheter or whole length
102
Q

describe a chemical occlusion

A

occurs suddenly during admin due to drug, mineral or lipid residue precipitate

103
Q

what are some risk factors in regards to chemical occlusions?

A
  • recent infusion/ incompatible drugs
  • medications with high risk for precipitation
  • high concentrations of calcium, phosphorus in parental nutrition
104
Q

what are signs and symptoms of a chemical occlusion?

A
  • line is sluggish/ difficult to flush

- vary depending on type of occlusion

105
Q

what is the treatment for chemical occlusion?

A
  • depends on cause

- consult pharmacist

106
Q

what are the causes of mechanical occlusions?

A
  • kinked tubing
  • cracks/ leaks in CVAD
  • constriction of CVAD due to improperly placed sutures at insertion site
  • catheter tip migration
  • malposition of catheter
  • closed clamp
  • client position
107
Q

what are the signs and symptoms of a catheter embolism?

A
  • palpitations
  • arrhythmias
  • cough
  • dyspnea
  • thoracic pain not associated c client’s diagnosis/ comorbidities
108
Q

what are some prevention methods you can do in regards to catheter embolism?

A
  • don’t withdraw catheter through needle during insurtion
  • never use vascular access devices for power injection
  • size of flush syringe should be appropriate for type of CVAD/ intended use
109
Q

what are interventions that can be done in regards to a catheter embolism?

A
  • upon removal inspect all catheters for damage/ fragmentation
  • notify MD / treat symptoms
  • save catheter/ report
110
Q

what are the signs and symptoms of a pulmonary embolism?

A
  • anxiety
  • dyspnea
  • tachypnea
  • pallor
  • cough
  • hemoptysis
  • diaphoresis
  • chest pain
  • lightheadedness
111
Q

what are prevention measures that can be done in regards to pulmonary embolism?

A
  • never irrigate catheter if IV not flowing
  • use in line filters
  • thoroughly inspect medication/ solution containers
112
Q

what are some treatments for pulmonary embolisms?

A
  • strict bed rest in semi fowlers position
  • notify physician ASAP
  • monitor vital signs
  • administer O2
  • assess CVC for patency
113
Q

describe Catheter migration

A

CVAD catheter migrates in/out changing position of tip

114
Q

what are signs/ symptoms of a catheter migration?

A
  • sluggish infusion/ aspiration
  • edema of chest/ neck
  • client complaint of gurgling in ear
  • dysrhythmias
  • increased external catheter length
115
Q

what are treatments for catheter migration?

A
  • stop infusion
  • re-confirm placement with CXR
  • consult c trained RN/ MRP
116
Q

describe arrhythmias

A

CVAD advanced into right atrium risk of irritating heart causing arrhythmia

117
Q

what are signs and symptoms of an arrhythmia?

A
  • abnormal heart rate and rhythm

- palpitations

118
Q

what are some treatments for arrhythmias?

A
  • oxygen
  • remove cause
  • treat symptoms
119
Q

What do you do if you suspect an occlusion (mechanical, thrombotic, or chemical)?

A
  1. stop infusion/ injection
  2. check IVAD for correct
    needle position/ replace non-coring needle
  3. have patient
    - take deep breaths/ cough
    - change positions
    - raise/ Lower arms
  4. flush VAD c 1-2mL NS
  5. reassess if not able t aspirate label catheter do not use
  6. contact MRP or IV nurse
120
Q

What do you do if you suspect catheter malposition?

A
  1. stop infusion/ injection
  2. change dressing
  3. do not re-insert catheter
  4. measure/ document new external length
  5. if more than 2cm label catheter do not use
  6. do not remove
  7. contact MRP or IV nurse

NRSG 202 (11 decks)

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