Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What are the types of CVADs?
|
- Non-tunneled
- Tunneled - Peripherally Inserted Central Catheter (PICC) - Implanted Vascular Access Device (IVAD) |
|
|
|
Describe a non-tunneled CVAD.
|
- Shorter term use
- Fast access - Higher rate of infection - 1-4 lumens - 6-8 inches in length - Inserted through a subclavian vein - Tip rests in superior vena cava (above the R atrium) - EXCEPT in a femoral CVAD: tip rests in the inferior vena cava |
|
|
|
Describe a tunneled CVAD.
|
- Long term use
- 1-3 lumens - Made of stronger medical grade silicon - Inserted by physicians in OR through subcutaneous tissue in chest - Usually exits around nipple level - 7-10 days after insertion, scar tissue forms around cuff (anchors catheter and stops microorganisms from migrating up tunnel) |
|
|
|
Describe a PICC.
|
- Intermediate term use (6 mo - 1 yr)
- Lower rate of infection - Inserted in peripheral vein by physician or certified RN - Tip rests in superior vena cava (above the R atrium) - EXCEPT in a midline catheter: tip rests in a peripheral vasculature |
|
|
|
Describe an IVAD.
|
- Long term use
- Implanted under skin with no external parts - May last for over 2000 punctures - Accessed with non-coring Huber needle - RN with special training to access port - Often seen in elderly or youth |
|
|
|
What are some complications with CVADs?
|
- Sepsis
- Air embolism - Thrombosis - Non-thrombotic occlusion - Pneumothorax - Cardiac tamponade |
|
|
|
What are S&S of sepsis?
|
- Local: redness, tenderness, warmth, purulent drainage, swelling, change in vital signs
- Systemic: fever, malaise, increased WBC |
|
|
|
What are the common causes of sepsis?
|
- Poor insertion technique
- Multiple lumens - Bacteria adhering to fibrin sheath - Frequent dressing changes or poor technique - Long term use - Immunosuppression |
|
|
|
What are the nursing interventions for sepsis?
|
- Notify physician of assessments
- Obtain orders for blood cultures, hold any antibiotic orders until cultures done - Apply warmth to insertion site - Monitor VS - Keep dressings dry if discharge - Check facility policies (eg. sending tip of catheter to lab for C&S) |
|
|
|
What are S&S of an air embolus?
|
- Chest pain
- SOB - Tachycardia - Decreased BP - Cyanosis - Dizziness |
|
|
|
What are the common causes of an air embolus?
|
- Taking in air during insertion, tubing changes, or catheter removal
- Catheter disconnected from extension tubing |
|
|
|
What are the nursing interventions for an air embolus?
|
- Emergency situation
- Clamp line - Place in trendelenburg - Provide oxygen therapy - Notify physician - Monitor vital signs |
|
|
|
What are the S&S of thrombosis?
|
- Swelling of arm and neck
- Fever - Malaise - Neck pain radiating to arm or back - Tachycardia |
|
|
|
What are the common causes of thrombosis?
|
- Reflux of blood into cathether due to poor positive pressure
- Poor flushing technique or frequent blood withdrawal - Catheter tip irritates vessel wall |
|
|
|
What are the nursing interventions for thrombosis?
|
- Slow IV infusion rate
- Apply warmth to site - Thrombolytic/anticoagulent agents may be used - Notify physician - Monitor vital signs |
|
|
|
What are the S&S of a pneumothorax?
|
- SOB
- Chest pain - Decreased chest sounds on affected side - Tachycardia - Decreased BP |
|
|
|
What are the common causes of a pneumothorax?
|
- Puncture of lung during insertion
- Infusion of air or fluid into pleural space may cause lung to collapse |
|
|
|
What are the nursing interventions for a pneumothorax?
|
- Elevate head of bed
- Notify physician - Provide oxygen therapy - Be prepared to assist physician with insertion of chest tube ore removal of central line |
|
|
|
What needs to be documented about CVADs?
|
- Assessment of insertion site and surrounding tissues
- Dates and times of changes - External length of catheter - Type of dressings - Flushes |
|
|
|
How can you prevent infection?
|
Use proper hand washing, meticulous site care, aseptic technique
|
|
|
|
How can you prevent breakage or rupture of catheters?
|
Avoid using small syringes, use 10 ml or greater
|
|
|
|
How can you prevent occlusion or thrombosis?
|
Daily turbulent positive-pressure flushing, check for blood return, confirm correct tip placement, monitor for leakage (sign of increased pressure)
|
|
|
|
How can you prevent an air embolus?
|
Clamp catheter when connecting or disconnecting the line, never leave uncapped, never use small syringes, secure catheter well
|
|
|
|
What is cardiac tamponade?
|
Compression of the heart that occurs when blood or fluid build up in the space between the myocardium (the muscle of the heart) and the pericardium (the outer covering sac of the heart)
|
|
|
|
How might cardiac tamponade happen with CVADs?
|
Infusing medications through a misplaced catheter tip causing pericardial effusion
|
|
|
|
What might happen if the tip of the catheter migrates into the atrium?
|
- Cause arrhythmias when touching SA node
- Entangle in tricuspid valve resulting valve replacement surgery - Pericardial infusion causing cardiac tamponade |
|
|
|
What is the SASH method?
|
An acronym to help remember proper flushing technique
- Saline - Administer drug (or withdraw blood) - Saline - Heparin |
|
|
|
What is the volume of most CVADs?
|
- 1-3 ml
- Flush with a volume that is at least twice the volume of the catheter and extension tubing |
|
|
|
What are the S&S of the tip migrating in the jugular vein?
|
- Patient hears bubbling in ear when catheter is flushed
- Sudden earache on the side of the catheter |
|
|
|
What are S&S of cardiac tamponade?
|
- Chest pain
- SOB - Forward leaning posture - Weakness/fatigue - Cyanosis - Anxiety - Swelling in abdomen - Weak peripheral pulses - Tachycardia - Distended jugular veins - Decline in pulse volume (difference between systolic and diastolic) |
Pressure on the heart -> decreased cardiac output and pain -> S&S
|
|
|
Why would you not get blood return?
|
- Fibrin sheath occlusion
- Huber needle is not fully inside IVAD - Malpositioning (tip against vessel wall) - Do NOT infuse medications or solutions through a CVAD without significant blood return |
|
|
|
What would you do if you suspect that the tip of the catheter is against the vessel wall?
|
- Have patient change position
- Have patient cough - Have patient perform Valsalva maneuver |
|
|
|
What are the common causes of a non-thrombotic occlusion?
|
- Fibrin build-up and lack of turbulent flush
- Precipitation from drug-drug or drug-solution incompatibility - Lipid accumulation from PN formulas - Tip moving against vessel wall |
|
