1
Q
reasons for cvad prescriptions
A
- vital for critically ill
- medications
- prolonged antibiotics admin
- iv fluids
- blood samples
2
Q
where cvads are placed
A
in the svc or ra
3
Q
types of cvads
A
- non tunnled
- tunneled (hickman)
- implanted infusion port (port-a-cath)
- picc line
4
Q
non tunneled cvads
A
- inserted directly into central vein
- 1 to 5 lumens
- highest risk of infection (short term use)
- fast access
- used for: blood abx, tpn, long term chemo
5
Q
tunneled cvads
A
- placed during surgery, inserted into the chest, and tunneled through percutaneous tissue (less chance for infection)
- verify placement via x ray
- can have 1 or more lumen
- synthetic cuff to anchor the catheter for stability
- long term use
- no dressing after healing
6
Q
implanted port (port-a-cath)
A
- chest wall pocket, surgically inserted into subclavian vein, tip in the svc
- long term use, over 1 year
- assess with a non coring (huber) needle
- gives freedom, little care
- commonly used for chemo
7
Q
picc lines
A
- inserted in basiclic, cephalic, brachial, or medial cubital vein of the arm
- 1 week to 6 months
- can be placed surgically or non surgically at bedside
- risk for infection
- monitor for crbsi
8
Q
contraindications for picc lines
A
- skin infection
- burns
- end stage renal failure
- crutches
- increased vasostimulation can cause movement of the veins and dislodge the catheter
9
Q
how to flush cvad ports
A
- aspirate blood return to check for placement
- flush with pulsating technique
- flush before and after meds, and every shift
10
Q
how to get blood sample via svad
A
- stop infusion for atleast 1 minute
- flush 10ml ns (if tpn infusing, flush with 20ml)
- use empty 10ml syringe to with draw 10ml blood, discard
- connect new syringe and withdraw amount of blood needed
- flush with 10ml ns, pulsating technique
- close safety clamp to maintain positive presure
11
Q
admin meds via cvad
A
- flush with 10ml saline
- open clamp
- aspirate blood return
- flush with saline
- attatch meds and admin at appropriate rate
- flush with saline
- maintain positive pressure
- close clamp
12
Q
cvad dressing change
A
- usually q 7 days
- assess for redness, swelling, drainage, tenderness, condition of dressing
- nurse and pt wear mask, nurse wear bonnet
- aseptic technique
- measure catheter length
- use chloraprep (blue sky to insertion site)
13
Q
discontinuing non tunnled cvad
A
- may require credentials
- position in supine lying down it insertion below level of heart, never sitting
- wash hands and don gloves
- remove old dressing and sutures
- gently pull catheter out while pt bears down (prevent entry of air)
- apply occlusive dressing immediately
- insepect catheter tip: intact, measure, compare length to insertion
- document
14
Q
potential cvad complications
A
- pneumothorax
- air embolism
15
Q
s/s of pneumothorax
A
- sob
- cough
- cp
- hypotension
- tachycardia
- anxiety
16
Q
s/s of air embolism
A
- dyspnea
- cp radiating to shoulder
- pale skin
- nausea
- hypotension
- light headed
- tachycardia
- decrease CO
- shock
- death
17
Q
response to air embolism
A
- clamp catheter and lumen clamps
- place on left side, head down
- check vitals
- apply o2 with o2 sat monitoring
- auscultate lungs
- call md, rt
- reassure pt
- iv access
18
Q
education for home care
A
- handwashing
- scrub hub
- frequent dressing changes
- keep pic dry
- avoid sharp pointy objects about picc
- watch if catheter length changes
- avoid lowering chest below waist
- avoid lifting anything heavier than 10 lbs
- drink plenty of water
19
Q
when to call hcp
A
- pain at catheter site
- fever
- chills
- vomiting
- coughing, wheezing, sob
- racing or irregular heartbeat
- s/s of infection
