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18 Cards in this Set

  • Front
  • Back
Duration of Central venous access devices
What to use if need for less than one week
What to use if need for more than a week
less than one week-Peripheral short Cath
More than a week-CVAD
what type of medications can you use with Peripheral short catheters in place
peripheral short catheters may only be used with osmolality less than 500 mOsm/L
Must not be vesicant or irritant
Direct insertion central venous catheters-explain
Sublclavian
Internal or external jugular
6-8 inches
one to four lumens
soft silicone or polyurethane
inserted by physician
14 gauge needle
wire through needle
feed catheter over wire into subclavian vein
when tip rests in vena cava-wire removed
Direct insertion -risks
emergency venous access when peripheral sites unsuitable
Irritating or caustic drugs-dopamine
Hypertonic or caustic drugs
Short term multiple access needs
Highest risk of insertion and problems with infection
Presence of tracheostomy increases risk of cross contamination
Don't use if burns, incisions, or radiation therapy in areas of insertions
Tunneled catheter-Describe
hickman, broviac and dialysis catheters

These catheters are tunneled under the skin from the vein insertion to a site on the chest
More resistant to infection
Designed for at home or long term use
can be used when high flow rates are required (as in dialysis or apheresis)
Decrease need for needle sticks
Active Patients
Hickman
Groshong
Flush: how much of what, how frequent,
Flush 5cc of NS--forcefully 30cc with TPN
Frequency: after each use or once a week
Dressing change: same as with other tunneled catheters
Flush with 30cc after drawing blood.
Picc-Describe
Non-tunneled catheters
Easily and quickly inserted by the radiologist or specially prepared nurse
Inserted through a vein in the arm to the central veins in the chest
Designed for short or intermediate term use.

Used for nutritional support or long term irritating drugs
Don't place if paralysis, arteriovenous grafts or lymphoedema in the arm
Implantable Vascular Devices
Completely implanted beneath the skin
Accessed by using a special needle --Huber needle
Long-term use
require very little maintenance when not being used
Lowest rate of infection
No restriction of activity
Always ascertain location before use
Ports are accessed via skin puncture with noncoring needle
Ports composed of self sealing silicone gel, surrounded by metal or plastic.
Complications of Cenral venous access Devices
Pneumothorax-tear in pleura, now we have air
hemothorax-blood in it
Occurs approximately 5% of insertions
Pneumothorax: collapse of lung causing air to fill pleural space. Hyperresonant on percussion.
Hemothorax: blood enters pleural space. Dull to percussion
Chylothorax: Collection of chyle (lymph fluid in pleural space. Dull to percussion.
S/S-sudden CP, SOB, cyanosis, asymmetrical chest expansion may have decreased H&H
Cause: puncture of lung, blood or lymph vessel
Allowing air, blood or lymph leak into pleural space
May occur 3-5 days after insertion if tear is small
Nursing action
Close observation
Immediately report chest pain or SOA
Administer O2
Infections that can lead to sepsis
S/S: fever, chills, elevated WBC, N/V, redness and drainage at insertion site
Nursing action
Sterile technique
Stop infusing IV's
Blood cultures (don't discard first specimen)
swab drainage
culture tip of catheter by swiping across medium
Start antibiotic therapy-broad spectrum
Central venous access Devices
Occlusion/Thrombosis
S/S:
SVCS super vena cava syndrome (dyspnea, cough, sensation of skin tightness, unilateral edema, cyanosis of face, distended jugular, temporal, and arm veins)
swelling below insertion point
pain along vein
earache or jaw pain
unilateral arm or neck pain
Sluggish flow rates
inability to flush or aspirate

Cause
Trauma to vein intima
Extended dwell time or short term catheter
Fibrin sheath
Sluggish flow rate
Inadequate flushing of each port
Prepare to possibly give fibrolytic to declot
Central venous access Devices
Occlusion/Thrombosis
Nursing Action
Nursing Action
Be sure each port gets flushed as recommended
Verify compatability of IV medications before administration
Raise arms overhead, cough and Deep breathe
Use polyurethane or silastic catheters
Venogram confirms presence
Monitor for Sx of P.E.
"Pulsatile flush with NS or heparin"
Silastic catheters may be declotted with trombolytic drugs
Drug precipitates may be dissolved with the installation of hydrochloric acid
Central venous access Devices
what are the signs and symptoms when a CVA device dislodges, what is the cause, what are the nursing actions?
S/S-Medication or fluid leaking from catheter or insertion site
Nursing actions:
Note presence of suture and amount of tubing protruding from insertion site
Report MD
Catheter rupture due to vigorous flushing
what are the signs and symptoms when a CVA device becomes infiltrated. What is the cause and what are the nursing actions?
S/S-Stinging/burning pain, redness, warmth and swelling along catheter. Leaking of fluid at catheter insertion site
Cause: catheter misplaced out of vessel. Catheter rupture due to vigorous flushing
Nursing actions: Stop infusion, do not use catheter until placement is verified by x-ray
Notify MD
determine cause
what are the signs and symptoms when a CVA device has an Air embolus in it. What is the cause and what are the nursing actions?
Air Embolus
S/S-Chest pain, anxiety, Increased HR, drop in BP, drop in O2 sat, loud churning over precordium.
Cause: Air entering central circulation usually via the central line
Nursing Actions:
clamp the central line
position pt on left side in trendelenburg
Notify the MD stat
Monitor VS and O2 sat
Obtain peripheral IV access
what are the signs and symptoms when a CVA device's catheter is damaged. What is the cause and what are the nursing actions?
S/S-Leakage from catheter or insertion site. Swelling in chest area
Cause: external: scissors, penetration with a needle,
Internal: rupture by use of smaller than 10 mL syringes, pinch-off syndrome

Nursing actions:
monitor for pin holes, leaks, wet dressing
External: clamp proximal to damage
Internal: stop infusion
Describe CVP and describe what is occuring when it is low and when it is high.
What should the nurse check-Assess
Central Venous pressure of a SWAN (blue tubing, port)
reflects pressure of blood in right atrium or vena cava end-diastole
Low CVP: hypovolemia or vasodilation
High CVP: Right ventricular failure, mechanical ventilation, hypervolemia
check breath sounds, HR, RR, JVD, U/O
May be referred to as Right atrial pressure
Describe Pulmonary Artery Pressure of A SWAN
pulmonary artery Pressure: (yellow tubing, port) reflects right ventricular function, pulmonary vascular status, indirect left ventricular status
a. PAWP- (pulmonary artery wedge pressure)
I. Occludes flow in branch of PA
ii. reflects LV end-diastolic pressure (function)
iii. Complications: Rupture of PA
b. Pulmonary Artery pressure
i. reflects resistance of pulmonary vasculature and LV end diastolic pressure
ii. Elevated with pulmonary vascular constriction i.e. PE, ARDS, LV failure, Pulmonary hypertension