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Med Surg I > Wk 2 Central Venous Catheters > Flashcards

Wk 2 Central Venous Catheters Flashcards

1
Q

4 reasons someone might have a CVC

A

TPN
Chemotherapy
Long-term antibiotic use
Loss of peripheral access

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2
Q

TPN is very __tonic

A

hypertonic, high in glucose, dextrose

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3
Q

The peripheral vein can’t handle

A

TPN because it is so hypertonic

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4
Q

Chemotherapy agents are __

A

vesicants

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5
Q

What are vesicants?

A

A blister agent, or vesicant, is a chemical compound that causes severe skin, eye and mucosal pain and irritation.

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6
Q

Deep central lines are __ __

A

Non-tunneled CVC

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7
Q

Where are deep CVCs (non-tunneled CVC) put in?

A

Subclavian vein
Internal jugular

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8
Q

Tunneled CVCs are put in by…

A

the surgeon in the OR and they are tunneled in subcutaneous tissue for the purpose of staying put

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9
Q

Deep lines, or non-tunneled CVCs are basically like an…

A

IV stick in the large vein

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10
Q

What are three examples of tunneled CVCs?

A

Hickman
Groshong
Broviac

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11
Q

Tunneled CVCs are frequently seen in __ patients

A

cancer

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12
Q

Implantable ports are also called…

A

portacaths or power port

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13
Q

What are implantable ports?

A

Implanted venous access devices that don’t have external tubing involved

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14
Q

What are the four types of CVCs

A

Non-tunneled CVC
Tunneled CVC
Implantable ports
PICCs

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15
Q

Where does the tip of a PICC stay?

A

superior vena cava or right atrium

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16
Q

PICCs are most commonly inserted in the…

A

ante cubical site

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17
Q

With a triple lumen deep line (TLDL), the medications and IV solutions come out at…

A

different places along the port, so you can hang things that are incompatible with each other

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18
Q

Where is the insertion site for a subclavian CVC?

A

Apex of the lung

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19
Q

If the provider perforated the pleura or apex while inserting a subclavian CVC, what might happen?

A

Pneumothorax

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20
Q

How many ports can a non-tunneled CVC have?

A

Up to 5

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21
Q

Who can put in a non-tunneled CVC?

A

MD or NP

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22
Q

How long is a non-tunneled CVC?

A

Typically 7-10 inches long

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23
Q

Where most often, does the tip reside for a non-tunneled CVC?

A

In the superior vena cava

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24
Q

What is most always done after a non-tunneled CVC is placed?

A

A chest x-ray because of the risk for a pneumothorax

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25
Q

A non-tunneled CVC is typically recommended for…

A

Short term, emergency, critical care, surgery

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26
Q

What is a non-tunneled CVC typically not recommended for?

A

Home/ambulatory clinic care

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27
Q

What are 4 complications of a non-tunneled CVC?

A

Bleeding at the site

Air embolism

Pneumothorax

CLABSI

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28
Q

CLABSI are the number 3 reason for

A

hospital acquired infections

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29
Q

Who removes non-tunneled CVCs?

A

Typically the RN

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30
Q

What should the nurse check before removing a non-tunneled CVC?

A

INR status to see if patient has clotting issues

31
Q

Why should a nurse use a measuring tape when removed a non-tunneled CVC?

A

To measure it and make sure that as much came out as went in

32
Q

What position will the patient be in when a nurse is discontinuing a non-tunneled CVC?

A

Supine or trendelenburg

33
Q

What will the nurse ask the patient to do when removed a non-tunneled CVC?

A

The Valsalva

34
Q

What is the valsalva maneuver?

A

Asking the patient to exhale through their mouth or hum

35
Q

What is the benefit of the valsalva maneuver?

A

Prevents atmospheric air from being sucked in to the big vessel when the catheter is pulled

36
Q

After the nurse removed the non-tunneled CVC, what should they do?

A

Hold pressure for 3-5 minutes, and apply an occlusive dressing

37
Q

What 4 supplies should the nurse have when removing a non-tunneled CVC?

A

Sterile suture removal kit

Sterile AND clean gloves

Occlusive dressing

Measuring tape

38
Q

Sometimes a provider may put in an order for the culture of the…

A

CVC tip after it has been removed

39
Q

What type of CVC is this?

A

Subclavian non-tunneled CVC

40
Q

What type of CVC is this?

A

Internal jugular non-tunned CVC

41
Q

What type of CVC is this?

A

Tunneled CVC

42
Q

What is the advantage of a tunneled CVC?

A

Stability, less likely that it will be pulled out

43
Q

Where are tunneled CVCs placed?

A

In the OR

44
Q

Three types of tunneled CVCs

A

Broviac

Hickman

Groshong

45
Q

When are tunneled CVCs used?

A

When treatment is frequent and prolonged (even years)

46
Q

What is the advantage of a tunneled CVC in comparison to an implanted port?

A

Doesn’t require needle sticks (implanted ports do)

47
Q

What is the disadvantage of a tunneled CVC in comparison to an implanted port?

A

With a tunneled CVC, there is a prolonged break in skin integrity

48
Q

Irrigation and site care of tunneled CVCs should be…

A

Followed per agency policy

49
Q

What are 4 complications of tunneled CVCs?

A

Catheter damage

Occlusion

Thrombosis

Sepsis

50
Q

Who will remove a tunneled CVC?

A

The provider

51
Q

What type of CVC is this?

A

Implanted Port (Portacath/PowerPort)

52
Q

What does the nurse use when it is time to give medication via a portacath?

A

Huber needle through a round device underneath the skin

53
Q

Who gets an implanted port?

A

Patients who require IV therapy up to a year or more

54
Q

Where is an implanted port placed?

A

In the OR, catheter attached to a port that is placed in a pocket made in SQ tissue on chest wall

55
Q

How many sticks can a patient with a portacath located in the chest have?

A

2000 sticks

56
Q

How many sticks can a patient with a portacath in the arm have?

A

750

57
Q

What is an advantage for the patient of the portacath?

A

No tubing, less impact on body image

58
Q

What is the site care for an implanatable port?

A

None when it isn’t being accessed

59
Q

For a portacath, if there is an ongoing infusion how frequent should you change the needle?

A

Weekly

60
Q

What is a complication of the imported caths?

A

Catheter occlusion

61
Q

Who will remove the implanted port?

A

HCP and they must make an incision to remove it

62
Q

What type of CVC is this?

A

Peripherally inserted central catheter (non-tunneled CVC)

63
Q

Where is a PICC line placed?

A

At the bedside

64
Q

Who will place a PICC line?

A

Certified RN, HCP, or radiologist

65
Q

How long do PICC lines last?

A

3-12 months

66
Q

Where are PICC lines placed on the body?

A

Typically the antecubital fossa; basilic or cephalic vein

67
Q

What should not be done on the arm that a patient has a PICC line on?

A

BP readings or blood draws

68
Q

With PICC lines, what complications do you not have?

A

Puncturing the lung or stickiness around the neck, so less microorganisms

69
Q

What is the site care of a PICC line?

A

Swab all caps with alcohol

Site change day after insertion

Site change every Wednesday (at UKHC) or when soiled

70
Q

What are complications of PICC lines?

A

Phlebitis

Occlusions

71
Q

Who removes a PICC line?

A

Nurse

72
Q

What types of CVCs can be removed by the nurse?

A

PICC

Non-tunneled CVCs

73
Q

How does a nurse remove a PICC line?

A

Have patient lie or sit down

Hold hand below level of heart

Have patient bear down while withdrawing

Measure length of PICC after removed

74
Q

Why should a nurse remove a PICC line inch by inch/slowly?

A

If you do it too fast it will cause vein spasms in the arm

Med Surg I (41 decks)

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