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IM2 > CVAD > Flashcards

CVAD Flashcards

1
Q

CVAD =

A

central venous access devices

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2
Q

what is a CVAD?

A

intravenous catheter or infusion port designed to administer medications, nutrients, IV fluids, and blood products

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3
Q

where is the CVAD placed?

A

central vein to the heart

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4
Q

one catheter has multiple __, ___, ___

A

lumens, gauges, and exits

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5
Q

_____ diameter for thicker fluids to go through lumens

A

larger

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6
Q

distal lumen is for

A

blood draw, blood infusions, medications, CVP

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7
Q

proximal lumen is for

A

IV fluids, medications, blood draw

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8
Q

medial lumen is for

A

TPN (total parental nutrition)

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9
Q

indications for CVAD

A

peripheral access not available or contraindicated, for moderate long-term use, need for multiple IV access, hemodialysis, TPN, chemotherapy, multiple blood transfusion, longterm abx/IV meds, and central venous pressure monitoring

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10
Q

___ the lumen/gauge the wider the diameter of needle

A

smaller

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11
Q

CVAD insertion: pre and post protocols

A

Dr’s order & signed consent, pre/post vital signs/assessments, initiate sterile mindset, pt in trendelenburg position, standby assist for physician/PICC team, X-ray confirmation

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12
Q

why do you place a patient in trendelenburg position for CVAD insertion?

A

enlarges vein and helps decrease chance for air embolism

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13
Q

types of CVAD

A

non-tunneled, tunneled, and Port-A-Cath

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14
Q

non-tunneled CVAD is most common and inserted directly into

A

subclavian, jugular, femoral, or peripheral vein

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15
Q

non-tunneled are secured by what and where?

A

sutures outside the insertion site to the skin

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16
Q

non-tunneled CVAD are used for how long?

A

acute, moderate to long term (approx. 6 weeks)

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17
Q

non-tunneled have a ____ rate of infection than tunneled

A

higher (because hanging outside skin, opened air into skin)

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18
Q

nurse can discontinue a non-tunneled because ___

A

it is not surgically implanted

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19
Q

PICC means

A

peripheral inserted central catheter

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20
Q

PICC- which two veins are used if what can be accessed?

A

cephalic or basilic vein; if the peripheral vein

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21
Q

if there is a PICC, what would you not perform?

A

no phlebotomy or blood pressures in arm

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22
Q

tunneled CVAD: broviac, groshong, hickman are done ____ & where?

A

surgically; beneath skin

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23
Q

tunneled CVAD are unique due to ____ cuff on the catheter and the cuff is ___ in place in _____ initially then scar tissue secures itself around the cuff

A

Dacron; surgically placed in SQ tissue

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24
Q

Dacron cuff helps secure and ___ ____

A

prevent infection

25
Q

common sites for tunneled CVAD:

A

subclavian vein, IJ (internal jugular vein), can also be placed in a femoral vein

26
Q

tunneled CVAD can have ____

A

multiple ports

27
Q

nurses cannot do what with tunneled CVAD?

A

discontinue because they need to be surgically removed because the dacron cuff needs to be cut out

28
Q

implanted port: port-a-cath, infusaport

A

surgically implanted line underneath

29
Q

implanted port: port-a-cath, infusaport are tunneled through

A

jugular, subclavian, or cephalic/basilic vein

30
Q

implanted port are long term: ____ to ____

A

month to years

31
Q

implanted port: port-a-cath, infusaport are used for ____ through a ____ or ____

A

chemotherapy; single or dual port

32
Q

____ needle to access an implanted port

A

huber

33
Q

CVAD knowledge & care (5)

A
  1. always assess the CVAD site before any interventions - sites/sutures/dressing/date, lumens/clamps, and fluids/meds
  2. always “scrub the hub” (max-zero cap) at least 15 seconds before accessing
  3. Always program CVAD infusions to a pump
  4. flush lumen(s) using only 10 mL flush syringes
  5. dressing changes
34
Q

when do you flush lumens?

A

every shift, after every medication, and after every blood draw

35
Q

when do you change dressings for CVAD?

A

24 hours post-insertion and every 7 days & PRN, the max-zero caps every 7 days with dressing change & PRN

36
Q

Complications of CVAD: CLABSI

A

central line associated blood stream infection - most common complication

37
Q

signs and symptoms of CLABSI

A

redness, drainage, swelling, discomfort at insertion site, fever, chills, tachycardia, and increased WBC

38
Q

nursing interventions to prevent clabsi

A

strict asepsis, never touch with bare hands, clean injection ports with alcohol swab before every access, assessment, dressing changes as indicated, pt/family teaching

39
Q

complications of CVAD: pneumothorax

A

air in the pleural space outside the lung (collapsed lung)

40
Q

signs and symptoms of pneuomothorax

A

dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, decreased breath sounds, obvious “chest deformity”

41
Q

nursing interventions for pneumothorax

A

monitor vital signs, administer oxygen, notify physician, CN, RRT, and prepare chest tube if indicated

42
Q

complications of CVAD: venous air embolism

A

air entering the circulatory system

43
Q

signs and symptoms of venous air embolism

A

acute dyspnea, chest pain, headache, confusion, hypotension, hypoxia, and tachycardia

44
Q

nursing interventions for venous air embolism:

A

keep lumens clamped, administer oxygen, monitor VS, pulse ox, place patient on left lateral side in trendelenburg position

45
Q

why do you place patient in trendelenburg position for a nursing intervention for venous air embolism?

A

trap air embolism in right atrium so it doesn’t leave and go to the rest of the heart or brain

46
Q

complications of CVAD: occlusion

A

lack of blood return or sluggish flow

47
Q

complications of CVAD: thrombosis

A

clot that blocks the catheter’s lumen

48
Q

complications of CVAD: catheter rupture

A

may be caused by excessive force used while flushing and wrong flush syringe

49
Q

complications of CVAD: catheter migration

A

displacement or lengthening of catheter

50
Q

catheter occlusion nursing interventions:

A

if no blood return or will not flush, have patient take deep breaths/cough, raise arms overhead/position arm on same side as the catheter, have pt sit up/stand up, change positions in bed, place in trendelenburg, administer alteplase

51
Q

alteplase is used for?

A

dissolve blood clots that have formed in the blood vessels

52
Q

CVAD catheter removal:

A

Dr’s orders, CVAD kit, suture removal kit, petroleum based gauze

hold pressure 5 minutes or until bleeding stops

53
Q

position for CVAD catheter removal:

A

supine position, hold breath, and pull line with deliberation

54
Q

how long do you hold pressure after CVAD catheter removal and remain in ____ position for at least ____ minutes post-removal

A

supine; 30 minutes

55
Q

CVAD catheter removal PICC line:

A

same as catheter removal, cover with occlusive dressing and leave on for 48 hours, must add 4x4 folded gauze over occlusive dressing & secure with Coban wrap, measure catheter length of PICC line and record, 30 min supine position

56
Q

how long do you leave on occlusion dressing after removal for CVAD?

A

24 hours

57
Q

CVAD dressing change steps:

A

gather supples (extra sterile gloves), introduce self and procedure, hand hygiene, identify pt, allergies/readiness, raise bed level of comfort, place patient in supine position with HOB 30 degrees if tolerated, position overbed table, hand hygiene, assess site/lumes/clamps, apply gloves/clean over-bed table, remove gloves, HH, open CVAD kit, then follow kit steps

58
Q

how long do you scrub the insertion site and what motion? what order?

A

30 seconds, back and forth, insertion site, hub, lumens

IM2 (14 decks)

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