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Flashcards in CVAD Deck (26)
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1

factors that determine which vascular access device is used

-length og IV infusion
-type of medication or product delivered
-patients healthy and individualized needs
-least risk of IV complications

2

what are the 3 type sou vascular access devices? and which ones are considered centrally inserted central lines?

-peripheral venous access
-middle catheter
-central venous access devices*

3

Central venous access devices

-terminal end lies in the central venous system, usually superior vena cava at the cavioartial junction
-have multiple lumens

4

used for CVAD

-IV fluid
-medications
-blood products
-Total parental nutrition
-chemotherapy
-hemodynamic monitoring
blood sampling

5

how are CVAD inserted generally?

-inserted under ultrasound to decrease insertion related complications, must have an x ray to confirm placement after inserting and before using

6

complications of CVAD

-CLABSI/ CRBSI
-air embolism
-pneumothorax insertion/migration
-thrombosis: clot

7

CVAD: peripherally inserted central line

-inserted into deep peripheral vein at antecubital space
-inserted by certified nurses
-provides long term venous access
-less infection and pneumothorax risk than other CVADs
-chest x ray to confirm placement

8

CVAD: non tunneled

-can be mutlip lumen are are central catheters
-inserted into jugular and subclavian
-short term therapy: 3-10 days
-high risk for CLABSI and pneumothorax
-sutured in place
-usually placed in emergent situations
-needs dressing

9

inserted in non tunneled line

-aspetic technique: need a wide sterile field and scrub with 2% chlorhexedine/gluconate
-CVC impregnanted with chorhexidine based aseptic
-trendelenburg position
-cover site with biopatch: transparent dressing or gaze that is only changed if non occlusive, soiled, or bloody

10

CVAD: tunneled line

-types: groshong, hickman, broviac, Raaf
-tunneled in SC tissue for 3-6 inches to exit site
-long term therapy
-lower risk for CLABSI than nontunneled
-less visible
-allows for ease of movement
-may or may not need dressing

11

CVAD: implanted port

-long term therapy
-proximal end implanted into SC tissue of upper chest
-no visible external ports of lines
-minimal daily care
-some discomfort with accessing device
-tip in subclavian vien

12

what factors determine choice of line?

-least risk for complications
-quality of life
-type of treatment
-length of treatment

13

important considerations of CVAD

-always look at policy for care
-listen to patinas c/o pain: always do exam instead of medication
-monitor IV site every hour at minimum

14

assessment of CVAD

-integrity of dressing
-s/s of infection
-palpate for tenderness
-measure length of exposed catheter

15

flushing a CVAD

-push pause method after every use
-use 10mL or large syringe
-3-5mL NaCl
-3mL heparin 100 unit/mL

16

changing CVAD dressing

-sterile procedure: mask, gown, gloves, and pt mask
-antimicrobial scrub: over site for 30 sec, 2inch radius, allow to dry
-changing the caps
-changing the tubing: every 24 hours for TPN

17

considerations for blood transfusion

-pre assessment
-patient identification
-new MD order every 24hrs
-equipment: y set filtered tubing and normal saline

18

blood transfusion guidelines

-remain at bedside of 5-15 minutes
-infuse slowly (25-50mL) for first 5-15 minutes
-4 hours maximum infusion time for PRBC

19

blood transfusions vitals

-before starting: VS and physical assessment
-every 5minutes 3 times, every 15 minutes 3 times, and every 30 minutes until complete

20

transfusion reaction symptoms

Allergic reaction: -hives, itching, anaphylaxis
Febrile reaction: -fever, chills, malaise,
hemolytic reaction: -immediate onset of fail flushing, chills, headache, low back pain, shock
Circulatory overload: -dyspnea, dry cough, pulmonary edema
Bacterial infection: hypertension, fever, flushed skin, abdominal pain

21

purpose of adding medication to a primary bag

-patient received the mediation slowly over long period of time
-typically mixed in the pharmacy bu can be done on unit

22

purpose of adding medications into secondary line/piggyback

-administer a medication intermittently during 24 hour period into primary line IV
-medication is mixed in 50-100mL

23

purpose of IV push through primary line

-deliver a single injection of medication directly into he vein to produce a rapid serum concentration
-use the port closest to the needle insertion sit

24

purpose of administering meds via mini infusion pump

-deliver meds in a small and controlled amounts over a prescribed period of time
-frequently used with children, older adults, and patients with cardiovascular problems

25

purpose of volume controlled infusion

-deliver meds or fluid in small amounts to patient with fluid balance concerns
-used in children, older adults, those on fluid restriction, and critically ill where volume control is important

26

purpose of IV push or intermittent infusion via lock

-deliver meds in a short period of time directly into the vein
-flush lock before and after with 2-3 NaCl: positive pressure method and pulsatile method