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Module 2 > Central Venous Access Devices- UNIT 1 EXAM > Flashcards

Central Venous Access Devices- UNIT 1 EXAM Flashcards

1
Q

What is a CVAD?

A

Intravenous catheter or infusion port

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2
Q

A CVAD is designed to administer what trough a central vein??

A
  1. Medications
  2. Nutrients
  3. IV Fluids
  4. Blood products and other viscous fluids
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3
Q

A CVAD contains one 1___ and multiple __2/__3__/__4_

A
  1. Catheter
  2. Lumens
  3. Gauges
  4. Exits
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4
Q

Distal Lumens are primarily used for? (may need to tweak after lecture

A
  1. Blood draw
  2. Blood infusion
  3. Meds
  4. CVP
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5
Q

Proximal lumens are primarily used for? (may need to reword after lecture)

A
  1. Iv fluids
  2. Meds
  3. Blood draw
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6
Q

Inserted into large veins in central circulation with catheter tip ending in ______. _____ confirmation.

A
  1. Superior Vena Cava
  2. Xray confirmation.
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7
Q

What are the indications for CVAD

A
  1. Peripheral access not available or contraindicated
  2. For patients that need moderate to long term use)***
  3. Need for multiple intravenous access
  4. Hemodialysis
  5. Total parenteral nutrition (TPN)
  6. Chemotherapy
  7. Multiple blood transfusions/blood draws
  8. Long term antibiotic/iv medications or solutions
  9. Central venous pressure monitoring
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8
Q

When preparing the patient for a central line what should you tell your patient.

A
  1. Purpose- What will be administered (meds, IV, fluids, etc)
  2. Estimated length of time. (most often the CVAD will be removed before patient leaves but sometimes it will go home with the patient)
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9
Q

What are the CVAD Insertion: Pre and Post Protocols?

A

1.Dr’s order & Signed consent
2. Support for patient/family- what to expect in the room,etc
- Surgical asepsis **
3. Pre and post vital signs/assessments
4. Pt in Trendelenburg position
5. Standby assist for physician/PICC team
6. X-ray confirmation
7. Documentation by both parties

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10
Q

What should we know about Port-A cath, Infusaports?

A
  1. Surgically implanted line below the skin-tunneled
  2. External, tunneled through jugular, subclavian, or cephalic/basilic vein
  3. Expensive
  4. Long term months to years
  5. Silicone septum, surrounded by titanium, stainless steel, or plastic
  6. Single or dual ports
  7. Chemotherapy
  8. Huber needle to access
  9. Less restrictive
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11
Q

What are 3 types of CVADS?

A
  1. Non tunneled
  2. Tunneled
  3. Port-A-Cath
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12
Q

What should we know about non-tunneled CVADs?

A
  1. inserted directly into subclavian (most common), jugular, femoral or peripheral vein.
    -(peripherally inserted central catheter = PICC line)
  2. Secured by sutures outside the insertion site to the skin
  3. Acute, moderate term, = 6weeks
  4. High infection rate than tunneled
  5. Nurse can discontinue
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13
Q

Why are non-tunneled CVAD at high risk of infection

A

More open to air

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13
Q

What are some complications of CVAD’s

A

1.Infection (CLABSI)
2. Pneumothorax
3. Air embolism
4. Occlusion
5. Thrombosis
6. Catheter Rupture
7. Catheter Migration

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14
Q

What should we know about Peripheral Inserted Central Catheter (PICC)?

A

Peripheral vein
1. Basilic or cephalic vein, IF peripheral vein can be accessed
2. PICC team or IR insertion
3. No phlebotomy or blood pressures in affected arm
4. Tend to clot easier

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15
Q

What should we know about Tunneled CVAD’s

A
  1. Surgically tunneled beneath skin
  2. Unique due to Dacron cuff on the catheter
    -Cuff is sutured in place (SQ tissue) initially then scar tissue secures itself around the cuff
    • Dacron cuff helps secure, prevent infection
  3. Common sites- Subclavian vein, IJ,
    • Can also be placed in a femoral vein
  4. Chronic, long term, >6weeks
  5. Multiple ports
  6. Nurse cannot discontinue” Must be surgically removed because of the Dacron cuff
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17
Q

When does a nurse assess?

A
  1. Dressing change (intact and within time from),
    2.med change (checking site),
    3.IV fluids,
    4.PRN
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18
Q

What are the signs and symptoms of an infection (CLABSI) in a CVAD?

A
  1. Redness
  2. Drainage
  3. Swelling
  4. Discomfort at insertion site
  5. Fever
  6. Chills
  7. Tachycardia
  8. Increased WBC
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19
Q

What are some Nursing interventions for an infection (CLABSI) in a CVAD?

A

1.Aseptic techniques
2.Clean injection ports with alcohol swab before EVERY access
3.Assessments and documentation
4.Dressing changes as indicated
5.Pt and family teaching

20
Q

What is a pnemothorax?

A

Air in the pleural space outside the lung
“collapsed lung”

21
Q

What are the signs and symptoms of a pnemothorax?

A
  1. Dyspnea,
  2. Hypoxia
  3. Tachycardia
  4. Restless
  5. Cyanosis
  6. Chest pain
  7. Decreased breath sounds
22
Q

What are the signs and symptoms of a pneumothorax?

A
  1. Dyspnea,
  2. Hypoxia
  3. Tachycardia
  4. Restless
  5. Cyanosis
  6. Chest pain
  7. Decreased breath sounds
23
Q

What is an air embolism?

A

Air entering the circulatory system

24
Q

What are the signs and symptoms of an air embolism?

A
  1. Dyspnea
  2. Chest pain
  3. Tachycardia
  4. Hypotension
  5. Anxiety
  6. Nausea
25
Q

What are some nursing interventions for an Air Embolism in a CVAD?

A
  1. Keep lumens clamed
  2. Admin o2, monitor VS, pulse ox
  3. Place patient on left lateral side in Trendelenburg position
  4. Stay with patient and notify physician, CN, RRT
26
Q

What are some nursing interventions for a pneumothorax?

A
  1. Monitor VS
  2. Admin o2
  3. notify physician, CN, RRT
  4. Prepare for chest tube, if indicated
27
Q

What is an occlusion?

A

Lack of blood return or sluggish flow

28
Q

What is a thrombosis?

A

Clot that blocks the catheter’s lumen

29
Q

What is a catheter rupture?

A

May be caused by excessive force used while flushing

30
Q

What is a catheter migration?

A

Displacement or lengthening of catheter

31
Q

Catheter Occlusion Nursing interventions: What can we have the patient try if there catheter does not have a blood return or will not flush?

A
  1. Take deep breaths/cough
  2. Raise arms overhead; reposition arm on same side as the catheter
  3. Have patient sit-up/stand-up
  4. Change position in bed
  5. Place in Trendelenburg
  6. Administer Alteplase
32
Q

True or false: It is important to know which type of CVAD is present?

A

True

33
Q

When assessing the CVAD site before interventions what are we looking at?

A
  1. Site/dressing/date
  2. Lumens/clamps
  3. Fluids and medications
34
Q

Always “scrub the hub” at least ___2_ seconds before accessing.

A
  1. 15 seconds
35
Q

True or false: You never have to program CVAD infusions to a pump?

A

False- Always program CVAD infusions to a pump

36
Q

Flush port/Lumen(s) with only ____mL of sterile saline

A

10

37
Q

When should you flush port/lumen(s)?

A
  1. Every shift
  2. After every medication
  3. After every blood draw
38
Q

CVAD knowledge & care protocol’s for dressing changes say…..

A
  1. Change dressing 24 hours post insertion & every 7 days or PRN
  2. Max-zero caps every 7 days with dressing change and PRN

May need to add to– after lecture

39
Q

What documentation should be included for replacing a dressing?

A
  1. Assessment of insertion site, sutures
  2. Site care performed per protocol/policy/sterile
  3. Type of dressing applied
  4. concerns/who was notified
  5. Site labeled with date, time, initials or school if stdt changes dressing
  6. external catheter length (PICC)
  7. Type of catheter # of lumens
    • flush easily, ports, clamps, antimicrobial caps, etc
  8. patient teaching
40
Q

Add dressing change instructions after lecture

A
41
Q

Add cvad cath removial :pic line after lecture

A
42
Q

What documentation should you include in catheter removal?

A
  1. Time and date
    2 Site condition and appearance
  2. any indicators of infection
  3. Culture obtained
  4. catheter length if indicated
  5. type of CVAD (# of lumens)
  6. any fluids infusing
  7. Concerns/ What & Who was notfied
  8. Patient teaching
43
Q

True or false: CVAD is a big umbrella term for many different central lines?

A

true

44
Q

What should you teach your patient about the CVAD and its care?

A
  1. What to avoid and why
    - No tugging/pulling
    -Sutures are intact
    - Dressing stay dry— occlusive dressings
45
Q

What should patients report about there CVAD?

A
    • Report anything abnormal – tenderness, pain, edges curling
46
Q

When preparing the patient about there CVAD what should we tell them about the schedule of care and how?

A
  1. Every 7 days or as needed
47
Q

When preparing the patient about post removal and care about a CVAD what should we tell them?

A
  1. Describe the process– even w/liquids (what it smells like, feels like, pain…)
  2. Make sure you inform them that it is a sterile procedure and try not move as much as possible.

Module 2 (14 decks)

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