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23 Cards in this Set

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1. List five benefits of central venous therapy: (text, p. 88)
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
Risks of central venous therapy
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
2. Name three potential vessels for placement of a central venous catheter: (text, p. 89)
1. Superior vena cava
2. Inferior vena cava
3. Peripheral vein
3. Define the difference between tunneled and nontunneled central venous catheters: (text, pp. 89-91)
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
Considerations when inserting:
1. presence of scars
2. tracheostomy (avoid internal or external jugular)
3. location of lung apices (mechanical ventilation)
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
Equipment
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
7. What patient parameters should the nurse monitor during and immediately after insertion of a central venous line? (text, pp. 110-111)
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
9. List five items the nurse should document regarding the catheter insertion: (text, p. 112)
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
Dressing changes:
change every 48 hrs if gauze/every 7 days if transparent
Preventing embolism
Perform valsalva's manuever and clamp port each time catheter hub is open to air
Flushing
heparin flush
SASH
normal saline in two way valve devices
frequency varies by device
before and after the administration of incompatible meds
CV line documentation
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
Catheter breakdown
do not use serated hemostat to prevent breaks in line and air embolism
Fibrin Sheath
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
4 common problems with CVT
fluid won't infuse
unable to draw blood
fluid leaking at the site
disconnected catheter
11.Describe the signs and symptoms of pneumothorax: (text, pp. 123-125)
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
12.Describe actions a nurse may take to aid in preventing pneumothorax related to central venous therapy: (text, p. 124)
head down during catheter insertion
assess for early signs of fluid infiltration
ensure immobilization
confirm CV assess device position with x-ray
14.What is the method to prevent air embolism when changing solutions and tubing on a central line? (text, p. 124)
valsalva's maneuver
ensure all air is purged from tubing prior to hook up
air eliminating filters
luer lock tubing
fluid won't infuse
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
unable to draw blood
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
fluid leaking at the site
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
disconnected catheter
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