1
Q
what would you do if you were unable to flush/ aspirate a line
A
suspect occlusion
Check for kinks in tubing
change dressing/ check site for:
- Kinks/ twists under dressing
- Tight sutures
- Obstructing securement device
- Remove end cap/ repeat patency assessment
if still not able to aspirate:
- Check for correct needle position/ replace non-caring needle
- Have pt take deep breath/ cough, change position, raise/ lower arm
- Flush with 1-2mL
- If able to aspirate flush with 20mL
- If not able to aspirate label do not use and notify IV nurse or MRP
2
Q
while doing the PICC dressing you notice that the catheter is longer than it was documented to be what would you do?
A
- Suspect catheter malposition
- Stop infusion
- Change dressing
- do not reinsert catheter
- Measure/ document new external length if greater than 2cm difference label do not use and notify IV nurse or MRP
- Consider need for PVAD PRN
- If length measured less than 2cm difference flush with 20mL
3
Q
What do you do if you removed a line and found the end was not intact?
A
notify MRP and or IV nurse ASAP
4
Q
What are the complications related to CVADs during insertion?
A
- arrhythmia
- Arterial puncture
- Pneumothorax
- Hemothorax
- Hydrothorax
- Injury to brachial nerve plexus
- Cardiac perforation
- Central vein perforation
- Catheter migration/ malposition
- Intolerance reaction
4
Q
What are the complications related to CVADs post insertion?
A
- Pulmonary embolism
- Phlebitis
- Infection
- Total occlusion
- partial occlusion
- venous thrombosis
- extravasation
- infiltration
- catheter fracture
5
Q
What are the complications related to CVADs in regards to the insertion and post-insertion
A
air embolism
6
Q
what are infusion-related complications for CVADs ?
A
- circulatory overload
- speed shock
- allergic reactions
- particulate matter
7
Q
What are LOCAL signs and symptoms of infections for CVADs?
A
-redness
- tenderness
- purulent drainage
- warmth
- edema at the insertion site
8
Q
what are systemic signs and symptoms of infections for CVADs?
A
- fever
- chills
- malaise
9
Q
what is used for the diagnosis of complications for CVADs?
A
- increased temp
- increased HR
- increased RR
- decreased BP
- altered LOC
- abnormal lab values (CBC, blood cultures, lactate)
10
Q
How do you treat LOCAL infections for CVADs?
A
- warm moist compresses
- culture of drainage from site
- catheter removal if indicated
11
Q
How do you treat SYSTEMIC infections for CVADs?
A
- IV fluids
- antibiotics
- sepsis protocols
- catheter removed if indicated and tip sent to lab for culture
12
Q
What is the role of the nurse when caring for a patient with a CVAD? What assessments and care are performed?
A
- assess length
- aspirate/ patency check
- assess for pain
- assess dressing
- assess surrounding skin
13
Q
What are the steps on how to change a PICC dressing?
A
- Check VAD care/ maintenance protocol
- Review policy for PICC dressing change
- Wash hands
- Gather supplies
- Introduce self to pt, verify with 2 identifiers
- Explain procedure
- Assess pt comfort level
- Wash hands
- Open dressing tray/ get supplies organized
- Don clean gloves
- Place sterile drape
- Instruct pt to face away from PICC arm
- Pull dressing off starting at the top and working way down and boarders leave translucent part of dressing intact
- Remove securement device
- Cleanse skin
- Secure lumen with new device
- Place securement device on skin
- Remove gloves/ clean hands
- Put on sterile gloves
- Use sterile forceps and remove remainder of dressing
- Assess catheter length/ and site
- Cleanse catheter site and surrounding skin
- Apply dressing
- Prime new needless cap/ replace old one
- Assess all lumens for patency and flush with 10mL NS
- Lock with heparin if required and close clamps
- Clean up and document
14
Q
What are the steps on how to collect a blood sample from a PICC?
A
- Obtain verbal consent from client
- Explain procedure/ if no refusal consider this consent
- Gather supplies
- Stop infusion for 2 minutes
- Attach NS flush syringe tp proximal lumen
- Check patency
- Withdraw 5-6mL blood into empty syringe discard
- Attach vacutainer fill to required volume repeat for as many vials as required
- Remove vacutainer connector
- Flush with 20mL NS
- If unable to clear all blood form needless cap complete cap change
15
Q
What are the steps on how to change a needless cap?
A
- Gather supplies
- Prep needless cap keeping it sterile
- Attach NS syringe/ prime with NS
- Scrub hub around old needless cap end with alcohol for 30 seconds
- Allow alcohol to dry
- Request client to turn head away from line
- Remove old needless cap
- Replace with primes new one
- Complete patency check/ flush
- Restart infusion
16
Q
where is the tip of PVAD located?
A
periphery
17
Q
where is the tip of CVAD located?
A
superior vena cava
18
Q
Where is the location of the insertion site for a PVAD?
A
hand to elbow - distal veins of the arm or in foot
19
Q
where is the location of the insertion site for a CVAD?
A
one of the following arteries:
- jugular
- cephalic
- basilic
- brachial
- subclavian
- femoral
20
Q
What is the catheter dwell time for a PVAD?
A
change site Q 72-96hrs or prn
21
Q
What is the catheter dwell time for CVADs?
A
PICC - 6 months to 1 year
central line
1. non-tunnelled 1 week
2. tunnelled up to 3 years
3. IVAD up to 5 years of # of punctures
22
Q
what types of infusions can be done through a PVAD?
A
short term
23
Q
what are the indications for a CVAD?
A
- chemotherapy
- long term
- TPN
- increased osmolality
- decreased pH
- higher irritant
- blood products
- obtain venous blood sample
- monitor central venous pressure
24
What is the rate of infusion that can be used for PVADs?
depends on medication/ fluid
25
what is the rate of infusion that can be used for CVADs?
- depends on medications/ fluids
- can take 2-3L/ minutes
26
Who can insert a PVAD?
- RN
- LPN (in some places)
- doctor
- anesthetist
- IV nurse
27
Who can insert a CVAD?
PICC - IV nurse
all other forms - surgeon while pt is under anesthetic
28
can you do blood sampling from a PVAD?
no
29
can you do blood sampling from a CVAD?
yes
30
can you do home IV therapy with a PVAD?
no
31
can you do home IV therapy with a CVAD? What are the types?
yes
- PICC
- IVAD
- hemodialysis line
32
what are the complication risks for PVADs?
- infection
- phelbitis
- thrombophlebitis
- fluid overload
- arterial puncture
- hemorrhage
- extravasation
33
what are the complications for CVADs?
same as PVAD plus:
- air/ catheter embolism
- pneumothorax
- hemothorax
- arrhythmia
- horner's syndrome
34
When do dressings need to be changed for PVADs?
- prn
- flush once/ shift if not infusing
35
When do dressings need to changed for CVADs?
- Q7 days
- prn
- flush Q12hrs or Q24hrs at home
36
where is a PICC inserted?
periphery in the :
- cephalic
- basilic
- median cubital vein
37
Where does the tip of the PICC rest?
lower portion of the distal superior vena cava
38
who inserts a PICC and what do they use?
IV nurse by using an ultrasound to insert and must have a chest x-ray after to verify position prior to using
39
how long can treatment last for a PICC?
1 month - 1 year
40
what forms can a PICC come in?
- valved
- non-valved
- single, double or triple lumen
41
Can you take a BP on an arm with a PICC in it?
no
42
What are CVADs that are non-tunnelled used for?
short term and emergent therapy
43
how long can treatment with a non-tunnelled CVAD last for?
< 7 days due to infection but could be up to 1 month
44
where is a non-tunnelled CVAD placed?
jugular or subclavian vein
45
how is a non-tunnlled CVAD place?
surgically by physician and needs to be verified with chest x-ray prior to use
46
why is a non-tunnelled CVAD sutured in place?
risk of bleeding if pulled out
47
what are the potential lumen sizes for a non-tunnelled CVAD?
single, double or triple
48
How long can a tunnelled CVAD be used for?
long term intermittently or continuously for more than 1 year
49
How long can a tunnelled CVAD be placed for?
indefinitely if there are no complications
50
how is a tunnelled CVAD placed?
surgically by physician and needs to be verified with a chest x-ray prior to use
51
what is the purpose of a Dacron cuff for a tunnelled CVAD?
- placed under skin
- creates seal to keep catheter from slipping out
- creates barrier from infection
52
How many lumens does a tunnelled CVAD have?
single, double or triple
53
what does IVAD stand for?
implanted vascular access device
54
what is another name for an IVAD?
surgically implanted ports or port-a-cath
55
what is a benefit of an IVAD?
decreased risk of infection for long term use
56
how long can an IVAD be used for?
long term intermittent or continuous access usually more than 1 year
57
describe the port on an IVAD
has reservoir with self sealing membrane and a catheter
58
how is an IVAD inserted?
surgically by vascular physician into SC pocket of chest
59
does an IVAD require a dressing when not in use?
no
60
does an IVAD require a dressing when in use?
yes
- aseptic, transparent dressing over Huber needle, side and tubing
61
who can access an IVAD?
HCP with further education
62
when accessing an IVAD what are you assessing for?
- site for dislodged port
- dislodging of catheter
63
if an IVAD port has dislodged what might you find?
- free movement of port
- swelling
- difficulty accessing
64
if an IVAD catheter tip has moved what might you find?
- neck or ear pain
- palpitations
65
if an IVAD is not in use how often does it need to be flushed?
at least every 8 weeks
66
does an IVAD require a heparin flush to maintain patency?
yes
67
why is it preferred to take a blood sample from a PICC if someone has one instead now?
- peripheral veins are no longer accessible or clinically significant reasons
- needle phobia
- client refusal
- risk of hemorrhage
68
are there any concerns around collecting a blood sample from a PICC?
- increased risk of catheter related infections
- CVAD occlusion
69
Which lumen do you use from a PICC when collecting a blood sample?
- largest lumen is best
- in multi lumen red one is for blood
70
when do you change a cap on a CVAD?
when blood is present in the cap and as per policy
71
can a student collect a blood sample from a PICC?
yes with RN supervision
72
How often should you assess a PICC/ CVAD?
- every hour for a continuous infusion
- every shift for saline locked
73
What would you do if the CVAD/ PICC external length had a 4-9cm length difference?
- stop infusion
- notify IV nurse/ MRP
- order X-ray to verify placement
74
what are some risks associated to taking blood samples from a PICC?
- hemolysis
inaccurate coagulation studies if line locked with heparin
- inaccurate therapeutic drug levels from medication admin
- catheter related blood infection from access
75
What are some benefits associated to taking blood samples from a PICC?
- decrease risk of hematoma from venipuncture
- vein preservation
- decreased pain/ anxiety from needle phobia
76
when should you change a PICC dressing?
dressing is:
- damp
- loosened
- visibly soiled
- moisture, drainage or blood present under dressing
77
When should you change a needless cap?
- Q4-7 days
- when unable to clear blood from cap
- sterility is compromised
- following blood sampling
- cap has been removed
78
What do you use to clean a PICC dressing site?
2% chlorhexidine with alcohol
79
What should a PICC dressing be labeled with?
- date
-time
- initials of the nurse
80
when removing a PICC dressing what direction do you do so in?
towards the insertion site
81
What are some complications of a PICC dressing change?
- migration
- bleeding at site
- introduction of contaminants leading to infection
- accidental removal of PICC
82
What are the steps for removing a PICC?
- verify physicians orders
- get patient to turn head away from PICC
- grasp catheter at insertion site
- withdraw slowly in 2-3cm increments
- do not apply pressure directly over catheter
- support surrounding tissue with sterile gauze
- place sterile gauze and large transparent dressing over site
83
What do you do if you feel resistance while removing a PICC?
stop and apply heat for 15 minutes to upper arm and shoulder then try again
84
What are the steps for removing a jugular or subclavian line?
- verify physician's orders
- practice val salsa with pt
- position pt in transdelenburg without pillows and have them turn their head away
- both pt and nurse should be wearing a mask
- don sterile gloves
- val salsa while drawing catheter and applying direct pressure over site with sterile gauze
- normal breathing while apply pressure for 5-10 minutes without occluding carotid artery
- place sterile/ large transparent dressing over site
85
What do you do if you have resistance while removing a jugular or subclavian line?
stop, tape in place and report to MRP
86
What do you do after post CVAD removal?
- assess site q15 mins for 1hr then hourly for hemorrhage
- monitor resp status q15mins for 1hr for SOB, PE
- minimize pt activity for 1hr, 2hrs for femoral
87
What do you do if you suspect an infection of the catheter?
cut off 1 inch of tip of catheter with sterile scissors and place in sterile C&S container, label, send to lab
88
how many people do you need when collecting sample for suspected infection of catheter?
2 people
89
how long do you hav to wait to remove CVAD dressing after line has been removed?
48hrs if no complications
NRSG 301
flashcards
Decks in class (5)
# Cards
