factors that determine which vascular access device is used
- length og IV infusion
- type of medication or product delivered
- patients healthy and individualized needs
- least risk of IV complications
what are the 3 type sou vascular access devices? and which ones are considered centrally inserted central lines?
- peripheral venous access
- middle catheter
- central venous access devices*
Central venous access devices
- terminal end lies in the central venous system, usually superior vena cava at the cavioartial junction
- have multiple lumens
used for CVAD
-IV fluid
-medications
-blood products
-Total parental nutrition
-chemotherapy
-hemodynamic monitoring
blood sampling
how are CVAD inserted generally?
-inserted under ultrasound to decrease insertion related complications, must have an x ray to confirm placement after inserting and before using
complications of CVAD
- CLABSI/ CRBSI
- air embolism
- pneumothorax insertion/migration
- thrombosis: clot
CVAD: peripherally inserted central line
- inserted into deep peripheral vein at antecubital space
- inserted by certified nurses
- provides long term venous access
- less infection and pneumothorax risk than other CVADs
- chest x ray to confirm placement
CVAD: non tunneled
- can be mutlip lumen are are central catheters
- inserted into jugular and subclavian
- short term therapy: 3-10 days
- high risk for CLABSI and pneumothorax
- sutured in place
- usually placed in emergent situations
- needs dressing
inserted in non tunneled line
- aspetic technique: need a wide sterile field and scrub with 2% chlorhexedine/gluconate
- CVC impregnanted with chorhexidine based aseptic
- trendelenburg position
- cover site with biopatch: transparent dressing or gaze that is only changed if non occlusive, soiled, or bloody
CVAD: tunneled line
- types: groshong, hickman, broviac, Raaf
- tunneled in SC tissue for 3-6 inches to exit site
- long term therapy
- lower risk for CLABSI than nontunneled
- less visible
- allows for ease of movement
- may or may not need dressing
CVAD: implanted port
- long term therapy
- proximal end implanted into SC tissue of upper chest
- no visible external ports of lines
- minimal daily care
- some discomfort with accessing device
- tip in subclavian vien
what factors determine choice of line?
- least risk for complications
- quality of life
- type of treatment
- length of treatment
important considerations of CVAD
- always look at policy for care
- listen to patinas c/o pain: always do exam instead of medication
- monitor IV site every hour at minimum
assessment of CVAD
- integrity of dressing
- s/s of infection
- palpate for tenderness
- measure length of exposed catheter
flushing a CVAD
- push pause method after every use
- use 10mL or large syringe
- 3-5mL NaCl
- 3mL heparin 100 unit/mL
changing CVAD dressing
- sterile procedure: mask, gown, gloves, and pt mask
- antimicrobial scrub: over site for 30 sec, 2inch radius, allow to dry
- changing the caps
- changing the tubing: every 24 hours for TPN
considerations for blood transfusion
- pre assessment
- patient identification
- new MD order every 24hrs
- equipment: y set filtered tubing and normal saline
blood transfusion guidelines
- remain at bedside of 5-15 minutes
- infuse slowly (25-50mL) for first 5-15 minutes
- 4 hours maximum infusion time for PRBC
blood transfusions vitals
- before starting: VS and physical assessment
- every 5minutes 3 times, every 15 minutes 3 times, and every 30 minutes until complete
transfusion reaction symptoms
Allergic reaction: -hives, itching, anaphylaxis
Febrile reaction: -fever, chills, malaise,
hemolytic reaction: -immediate onset of fail flushing, chills, headache, low back pain, shock
Circulatory overload: -dyspnea, dry cough, pulmonary edema
Bacterial infection: hypertension, fever, flushed skin, abdominal pain
purpose of adding medication to a primary bag
- patient received the mediation slowly over long period of time
- typically mixed in the pharmacy bu can be done on unit
purpose of adding medications into secondary line/piggyback
- administer a medication intermittently during 24 hour period into primary line IV
- medication is mixed in 50-100mL
purpose of IV push through primary line
- deliver a single injection of medication directly into he vein to produce a rapid serum concentration
- use the port closest to the needle insertion sit
purpose of administering meds via mini infusion pump
- deliver meds in a small and controlled amounts over a prescribed period of time
- frequently used with children, older adults, and patients with cardiovascular problems
