CVAD Flashcards

(45 cards)

1
Q

Wha tis a CVAD?

A

Central Venous Access Device: Allows for administration of things directly into the Superior Vena Cava/Heart

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2
Q

Whatre the 3 lumens coming from the one Catheter on the CVAD used for/

A

Distal: Blood draws/infusions, meds and CVP
Medial: TPN (Thick nutritional substance)
Proximal: IV Fluids, meds

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3
Q

Where do you insert a CVAD and where does it lead?

A

Insert into a large central vein to lead to the superior vena cava/right atrium

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4
Q

How do you confirm the placement of a CVAD?

A

X ray

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5
Q

Why are we slightly moving away from the use of a CVAD?

A

High infection rate

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6
Q

How long are CVADs used for typically?

A

Moderate-long term use

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7
Q

Indications/Reasons for CVADs?

A
  • Need for multiple intravenous access
  • Hemodialysis
  • TPN
  • Chemo
  • Multiple blood transfusion/blood draws
  • Long term antibiotics/IV meds
  • Central Venous Pressure monitoring
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8
Q

What is different about the numbers for measuring lumens’ sizes?

A

Smaller numbers mean bigger

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9
Q

What should we tell the patient when working with CVADS?

A
  • Purpose: what will be administered
  • Estimated length of time of how long they’ll have the CVAD
  • Inform that it is a sterile procedure and what to expect because of it
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10
Q

What is needed for CVAD insertion?

A
  • Doctors orders and Signed Consent of pt
  • Pre and post Vitals
  • Sterile Mindset
  • Pt in trendelburg position
  • PICC team
  • Xray Confirmation
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11
Q

Why do we put pt’s in the trendelenburg position for CVAD insertion?

A

It enlarges the veins to make insertion easier and to lower the chance of an air embolism

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12
Q

What are the 3 types of CVADs?
Which one is the most common?

A
  • Non tunneled (Most common)
  • Tunneled
  • Port a cath
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13
Q

Where does a Non tunneled CVAD go?

A

-Directly into with the Subclavian, Jugular, Femoral, or Peripheral vein

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14
Q

How long are non tunneled CVADs used for?

A

~ 6 weeks

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15
Q

How are non tunneled catheters secured?

A

Sutures outside of the insertion site to the skin

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16
Q

Why do non tunneled CVADS have a higher infection rate?

A

There’s a direct opening into the skin

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17
Q

Why can nurses discontinue CVADs?

A

Cause they were not surgically implanted

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18
Q

What does PICC stand for?

A

Peripherally Inserted Central Catheter

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19
Q

Where are PICC lines inserted?

A

The two peripheral veins, Basilic or Cephalic, whichever can be assessed

20
Q

Why can you not do phlebotomy or take BP in arms with a PICC line?

A

PICC lines are in the way to take BP and PICC lines can be used to draw blood as well

21
Q

How are Tunneled CVADs implemented?

A

They’re surgically implaneted beneath the skin

22
Q

How are tunneled Catheters unique?

A

there is a Dacron Cuff on the catheter

23
Q

How is the Dacron Cuff secured?

A

Placed SubQ and then secured when scar tissue forms around it

24
Q

Common sites for Tunneled CVADs.

A

Subclavian Vein, IJ, and Femoral Vein

25
How long are Tunneled CVADs for?
Chronically/Longterm (Greater than 6 weeks)
26
Tunneled CVADs have multiple-
Ports
27
Can Nurse discontinue Tunneled CVADs?
No, they must be surgically removed
28
How are implanted ports(Port a cath) inserted?
Surgically implanted beneath the skin.
29
Where are Implanted ports located?
Tunneled through the jugular, subclavian, or cephalic/basilic veins
30
How long are Implanted Ports used for?
Months to years
31
How do you access Implanted ports?
Huber needle
32
Implanted ports are less-
Restrictive, theyre under the skin when healed so there's no obstruction
33
5 knowledge and care protocols for CVADS
- Always assess the CVAD site before any intervention - Always Scrub for at least 15 seconds - Always program CVAD infusions to a pump - Flush Lumens using only 10mL syringes - Change Dressings 24 hours after insertion and then q 7 days and PRN
34
What do you assess for when looking at CVAD insertions?
- Sutures and dressing and their dates - Lumens, Clamps, and Caps - Fluids/Meds
35
When should you flush Lumens?
- q Shift - After every Med - After every blood draw
36
What is CLABSI?
Central Lab Associated Blood Stream Infection (The most common complication with CVADs)
37
Signs and Symptoms of CLABSI
- Redness - Drainage - Swelling - Discomfort - Fever - Chills - Tachycardia - High WBC count
38
How to prevent CLABSI?
- Strict Asepsis - Never touch with bare hands - Clean with alcohol swab before EVERY access - Assessments and report concerns - Change dressings as indicated - Pt/family teaching
39
Signs and Symptoms of a pneumothorax
- Dyspnea - Hypoxia - Tachycardia - Restlessness - Cyanosis - Chest pain - Lower breath sounds - Chest deformaties
40
Interventions for pneumothorax
- Monitor Vital - Give O2 - Notify physician, CN, RRT - Give chest tube if indicated
41
Signs and Symptoms of a Venous air embolism
- Dyspnea - Chest pain - Headache - Confusion - Hypotension - Hypoxia - Tachycardia
42
Nursing interventions for Venous air embolisms
- Keep Lumens Clamped - Give O2 - Monitor Vitals - Place pt on left lateral side in Trendelenburg position
43
For a pt with a Venous air embolism, why do we place them how we do?
Tries to keep the air embolism trapped
44
4 other complications of CVADs?
- Occlusion: Lack of blood return or sluggish flow - Thrombosis: Clot that blocks lumens - Catheter Rupture: May be caused by excessive force while flushing with wrong syringe - Catheter Migration: Displacement or lengthening of catheter
45