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57 Cards in this Set
- Front
- Back
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CVAD – NOTES/ POSSIBLE TQ
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X
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When should a CVAD be used instead of a peripheral catheter? Examples.
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- Need high fluid vol./high caloric needs (TPN)(Burns, Cancer, Sepsis)
- Extremely irritating meds (Cancer, Sepsis) - Hemodynamically unstable (Sepsis) - complicated surgical procedures (CABG) |
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Why is CVAD chosen for certain meds or TPN?
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- Inserted in large vessels w/ high blood flow
- Concentrated or irritating solutions are rapidly diluted by the blood in these vessels. |
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Central Venous Access Veins
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see pic
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Which blood vessels are typically chosen for the CVAD? Why?
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-Internal jugular vein, subclavian vein, & femoral vein (last choice)
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Why are pts w/ Crohn’s disease, ciliac disease, & tropical sprue good candidates for a central line?
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These are mal-absorption diseases. Unable to absorb nutrients from the GI tract. So TPN is ordered
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Why would pts w/ acute pancreatitis or extensive bowel surgery require a central line?
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they need “bowel rest”, so TPN is ordered
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What are some goals of Parenteral Nutrition?
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-establish a positive nitrogen status
-improve nutritional status -maintain muscle mass -promote weight maint. or gain -enhance the healing process |
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What happens if the nitrogen status in negative?
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the body breaks down muscle for energy
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Nursing considerations for parenteral nutrition:
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-Assess the site & dressing
-Assess for fluid volume overload -Order changed daily -Hang D10 or D5 if TPN or PPN (respectively) “run out” before more is made -Check blood blucose -Know if it is continuous or cycled |
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What is the difference between Continous vs Cycled Parenteral Nutrition
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-Continous is given all day
-Cycled is generally given at night when sleeping, eat regular meals during the day |
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How often is an ordered changed?
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daily – very pt specific, pt’s status & requirements could change often
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What is done when TPN or PPN “runs out” before the next bag is prepared?
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hang a D10 bag until the TPN is ready – the pancrease is used to the TPN or PPN w/ a lot of dextrose and will keep producing the same amount of insulin as if it’s still getting it. The D10 will hold it over until the TPN comes.
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Categories of Central Lines are related in terms of:
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length of therapy
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What are the categories of Central Lines?
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1. Short-term = up to 30 days
2. Intermediate = 30 – 45 days 3. Long-term = greater than 45 days |
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Which is the choice Central Line Catheters?
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PICC: Peripherally Inserted Central Catheter
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Types of Central Line Catheters?
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-PICC: Peripherally Inserted Central Catheter
-Non-tunneled -Tunneled -Implanted Ports |
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Describe Non-Tunneled & Tunneled Central Line Catheters
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-Non-Tunneled
-sutured in place at the insertion site, directly through the skin & into the vein -catheter & attachments protrude directly - multiple lumens -Tunneled -Long-term -goes under skin for a length before hit vein |
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Nontunneled CVC Line
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see pictures
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Tunneled CVC Line
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see pictures
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Where are nontunneled percutaneous CVCs inserted?
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-jugular, subclavian, or femoral veins
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Why would tunneling be preferred over non-tunneling?
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less chance for infection
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What is required for all Central Lines before beginning use? Why?
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X-Ray – ensure hit superior vena cava
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Describe a Multilumen Subclavian Catheter
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-non-tunneled percutaneous central catheter
-short-term, up to 30 days -has 1 – 4 lumens -increased risk of infection from that of tunneled |
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Possible complication (other than infection) w/ catheter in subclavian vein?
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pneumothorax
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When would you use the femoral vein for a central catheter?
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If the subclavian line is contraindicated (critical care & ER settings)
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What primary considerations go with a Femoral Line?
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-VERY short term, 1 – 2 weeks
-move location as soon as possible |
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Why is the Femoral line the least desireable?
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-High risk for complications & infections
-accounts for most catheter-related blood stream infections |
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How long can a PICC line stay in?
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3 – 6 months
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PICC Line
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see pictures
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PICCs are only replaced as needed, what reasons might cause a change?
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no longer patent or site looks infected
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Why are some benefits to using a PICC?
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-less risk of complications (infection/pneumothorax) due to peripheral insertion
-cost effective while providing adequate hemodilution for meds |
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Two types of Tunneled Central Catheters?
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-open ended (Hickman/Broviac)
-valved (Groshung catheters) |
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Why would Tunneled Central Catheters be the choice for Dialysis pts?
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because they are long-term (several years)
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What is special about the Groshung catheter?
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some have one-way pressure valves (no need to clamp)
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Hickman Catheter
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see pic
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Groshung Catheter
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see pic
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Port-a-Cath, # of lumen & length of use?
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-can stay in for several years
-has one lumen -may have an internal pump to release meds slowly |
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Port-a-Cath, type of needle to access?
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Huber needle
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Implanted Ports
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see pics
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Complications with CL?
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-sepsis/infection (mask & sterile technique)
-thrombosis (blood clot) -phlebitis (redness, irritation) -Air embolus, more common in CL than peripheral (from flushing/priming, etc.) -occluded |
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Which type of central catheter has least risk of blood-stream infections?
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implanted ports
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Interventions if CL is occluded
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-sit up, raise arm
-cough -TPA [tissue plasmin activator (small anti-coagulant)] -change cap -do not force |
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What should you check if pt is uncomfortable?
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-infusion (going to vein, rate too fast?)
-pt position -pt’s circulatory status -pt anxiety |
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How often should a Central Line be flushed?
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q8h & after each use (check hospital policy)
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Size syringe & how much to flush with?
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-10cc syringe, flush q/ 3-10 cc or NS
-After blood draws, flush w/ 20cc |
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Flushing w/ valved vs. non-valved catheters
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-non-valved, maintain pressure w/ plunger while clamping (necessary)
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Main concern when changing a valved cap on valved catheter?
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-clamp when changing
-flush new cap before attaching |
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When removing a central line, what position should pt be in?
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lying flat
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Indications for removal of a CL?
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-improvement of status
-infection -length of time |
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Complications when removing a CL?
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-Catheter not intact
-resistance |
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Difference in concentration between TPN &PPN (hypertonic, hypotonic & isotonic)?
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-TPN is hypertonic while PPN is isotonic.
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TPN contains the 3 primary components of nutrition: ______, ______& ____________? As well as: ______, __________, & _________?
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- protein, carbs, & fats
-electrolytes, vitamins & trace elements |
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What would be the best position of the pt when working with a PICC line? Why?
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-comfortable positions w/ arm extended from the body below heart level.
-reduce risk of air embolism |
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What’s the main purpose of the clear dressing?
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protects site, prevents accidental dislodgement or removal of needle
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To do if PICC is dislodged during dressing change?
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-If not all the way out, notify the PCP. Will most likely want X-ray to see location of line’s end. Before X-ray, reapply dressing so doesn’t further dislodge.
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To do if purulent drainage is noted at the insertion site when dressing is removed?
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-obtain a culture, clean area, reapply dressing, notify PCP (before sending culture).
-prevents line from being open while notifying PCP and the culture is obtained w/o removing the dressing again if PCP wants the culture. -if PCP doesn’t want the culture, discard it |
