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18 Cards in this Set
- Front
- Back
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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 |
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what type of medications can you use with Peripheral short catheters in place
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peripheral short catheters may only be used with osmolality less than 500 mOsm/L
Must not be vesicant or irritant |
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Direct insertion central venous catheters-explain
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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 |
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Direct insertion -risks
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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 |
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Tunneled catheter-Describe
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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 |
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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. |
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Picc-Describe
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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 |
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Implantable Vascular Devices
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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. |
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Complications of Cenral venous access Devices
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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 |
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Infections that can lead to sepsis
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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 |
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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 |
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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 |
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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 |
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what are the signs and symptoms when a CVA device becomes infiltrated. What is the cause and what are the nursing actions?
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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 |
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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?
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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 |
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what are the signs and symptoms when a CVA device's catheter is damaged. What is the cause and what are the nursing actions?
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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 |
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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 |
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Describe Pulmonary Artery Pressure of A SWAN
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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 |
