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23 Cards in this Set
- Front
- Back
- 3rd side (hint)
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1. List five benefits of central venous therapy: (text, p. 88)
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1. Access to central veins
2. Extra rapid infusion of medications or large amounts of fluids 3. A way to draw blood samples and measure CV pressure, an important indicator of circulatory function 4. Reduced need for repeated venipunctures, which decreases the patient's anxiety and preserves the peripheral veins 5. reduced risk of vein irritation from infusing irritating or caustic substances |
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Risks of central venous therapy
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1. pneumothorax
2. sepsis 3. thrombus formation 4. perforation of the vessel and adjacent organs 5. more time and skill to insert 6. costs more to maintain 7. risk of air embolism 8. greater risk of infection |
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2. Name three potential vessels for placement of a central venous catheter: (text, p. 89)
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1. Superior vena cava
2. Inferior vena cava 3. Peripheral vein |
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3. Define the difference between tunneled and nontunneled central venous catheters: (text, pp. 89-91)
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1. Tunneled: long term use, made of silicone (less chance of thrombosis), cuff to encourage rissue growth, radiopaque
2. Nontunneled: Radiopaque, short term use, need to be changed and carefully monitored, remove promptly if signs of infection are present |
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Considerations when inserting:
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1. presence of scars
2. tracheostomy (avoid internal or external jugular) 3. location of lung apices (mechanical ventilation) |
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1. presence of scars
2. tracheostomy (avoid internal or external jugular) 3. location of lung apices (mechanical ventilation) |
Explanation: understanding of procedure?, movement restrictions, cosmetic concerns, management regimes/home care (valsalvas, dressing changes)
Sterile procedure = glove, gowns, mask Positioning - trendelenburgs for subclavian/jugular vein, rolled towel between scapulae (subclavian), rolled towel under opposite shoulder (jugular) Feel: warm stinging sensations, pressure Remove hair, clean site Testing: venogram, blood samples Monitor how patient tolerates procedures, coach on when to use valsalvas |
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Equipment
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1. administration set, infusion pump
2. gowns, caps, gloves - possibly for the patient too 3. attach the tubing, prime the tubing, prime and calibrate pressure monitoring setups 4. ensure aseptic, no air in tubing, tight connections and caps |
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7. What patient parameters should the nurse monitor during and immediately after insertion of a central venous line? (text, pp. 110-111)
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1. Arrhythmias- catheter can enter right atrium or left ventricle, palpate radial pulse
2. Ensure line is capped and flushed with normal saline until after ex-ray confirms placement 3. Dressing application: clean site, cover with transparent semipermeable dressing, seal with nonporous tape 4. Elevate HOB 45 degrees |
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9. List five items the nurse should document regarding the catheter insertion: (text, p. 112)
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1. Type of device used
2. Location of insertion 3. Catheter tip position as confirmed by x-ray 4. Patient's tolerance of procedure 5. Blood samples taken 6. Length of catheter outside of body |
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Dressing changes:
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change every 48 hrs if gauze/every 7 days if transparent
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Preventing embolism
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Perform valsalva's manuever and clamp port each time catheter hub is open to air
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Flushing
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heparin flush
SASH normal saline in two way valve devices frequency varies by device before and after the administration of incompatible meds |
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CV line documentation
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type, amount, rate of infusion
dressing changes; appearance of site and catheter how the patient tolerated tubing and solution changes cap changes flushing procedures blood samples collected |
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Catheter breakdown
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do not use serated hemostat to prevent breaks in line and air embolism
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Fibrin Sheath
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may develop at tip of catheter
impedes blood flow/good environment for bacteria may be able to infuse fluids but not aspirate blood remove surgically or instill thrombolytic agent |
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4 common problems with CVT
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fluid won't infuse
unable to draw blood fluid leaking at the site disconnected catheter |
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11.Describe the signs and symptoms of pneumothorax: (text, pp. 123-125)
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chest pain
dyspnea to acute respiratory distress cyanosis decreased or absent breath sounds on the affected side to asymetrical chest wall movement and tracheal shift away from affected side |
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12.Describe actions a nurse may take to aid in preventing pneumothorax related to central venous therapy: (text, p. 124)
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head down during catheter insertion
assess for early signs of fluid infiltration ensure immobilization confirm CV assess device position with x-ray |
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14.What is the method to prevent air embolism when changing solutions and tubing on a central line? (text, p. 124)
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valsalva's maneuver
ensure all air is purged from tubing prior to hook up air eliminating filters luer lock tubing |
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fluid won't infuse
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Causes:
1. closed clamp 2. displaced or kinked catheter 3. thrombus |
Interventions
1. check infusion system/clamps 2. change patient's position 3. have patient cough, deep breathe, perform valsalvas 4. remove dressing, examine external portion of catheter 5. x-ray 6. try to withdraw blood 7. gentle saline flush |
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unable to draw blood
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Causes:
1. Closed clamp 2. Displaced, kinked catheter 3. thrombus/fibrin sheath 4. Catheter movement against vessel wall with negative pressure |
Interventions:
1. Check infusion system and clamps 2. change patient's position 3. have patient cough, deep breathe, perform valsalvas 4. Remove dressing, examine external portion of the catheter 5. x-ray order to check catheter tip placement |
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fluid leaking at the site
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Causes:
1. Displaced or malpositioned catheter 2. Tear in catheter 3. Fibrin sheath |
Interventions
1. check for signs of distress 2. change dressing, observe for redness 3. notify practitioner 4. obtain x-ray order 5. prep for catheter change 6. repair kit |
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disconnected catheter
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Causes:
1. Patient moved 2. Not securely connected to tubing |
Interventions
1. Catheter clamp 2. Sterile syringe 3. Change IV extension set 4. Clean the catheter hub 5. Connect clean IV tubing or hep lock plug to site 6. restart infusion |
