CVAD's Flashcards
(94 cards)
1
Q
What is a CVAD ?
A
it is an indwelling catheter inserted into the vein of the central vascular system (Central Venous Access Device)
2
Q
Where is a CVAD inserted ?
A
Internal/External Jugular Vein
Subclavian Vein
Basilica/Brachial Vein
3
Q
How far does a CVAD catheter go into the body ?
A
The tip of the catheter is usually located in the lower third of the Superior Vena Cava or into the junction of the Right Atrium
4
Q
What are the 4 types of CVAD’s ?
A
- Non-tunnelled Percutaneous Catheter (CVC)
- Externally tunnelled Catheter (Hickman)
- Peripherally Inserted Central Catheter (PICC)
- Implanted Venous Access Device (IVAD)
5
Q
What are CVAD’s used for (8) ?
A
- Administer IV fluids and blood products
- Administer IV meds and multiple incompatible meds at once
- Administer hypertonic solutions (TPN, Chemo, Vesicant meds, Irritants, Extreme pH meds)
- Obtain blood samples
- Provide LT IV access/therapy
- Venous access in when peripheral access is difficult
- Hemodialysis access
- Monitor central venous pressure in ill patients
6
Q
Where is a Non-Tunnelled Percutaneous CVAD inserted ?
A
Subclavian, Jugular or Femoral Vein
7
Q
Is a Non-Tunnelled CVAD LT or ST ?
A
Short term therapy (days to weeks)
8
Q
How many lumens can a Non-tunnelled CVAD be ?
A
1 - 3 lumens (based on patient and therapy)
9
Q
T or F: A Non-Tunnelled CVAD is surgically implanted
A
F, It is not
10
Q
How is a Non-Tunnelled CVAD held in place ?
A
Sutures
Manufactured Securement Device
11
Q
Why is it called a Non-Tunnelled CVAD ?
A
It is externally clamped and not valved
12
Q
What is an example of a Non-Tunnelled CVAD ?
A
CVC
13
Q
Where is a Externally Tunnelled CVAD inserted ?
A
Chest region:
Subclavian Vein
Jugular Vein
14
Q
Is an Externally Tunnelled CVAD LT or ST?
A
Long-term therapy
- often referred to as permanent
15
Q
T or F: An Externally Tunnelled CVAD is surgically implanted
A
True
16
Q
How is an Externally Tunnelled CVAD held in place ?
A
Dacron cuff coated in antimicrobial solution
17
Q
What is an example of an Externally Tunnelled CVAD ?
A
Hickman/Permacath
18
Q
Where is a Peripherally Inserted Central Catheter inserted ?
A
anywhere from the Antecubital fossa to the upper arm (basillic/cephalic)
19
Q
How far is the Peripherally Inserted Central Catheter inserted into the body ?
A
It is fed up to the Superior Vena Cava
20
Q
Is the PICC LT or ST
A
Long-term therapy (days - months)
21
Q
How many lumens can the PICC line have ?
A
1 - 3 lumens depending on patient and therapy
22
Q
Most PICC lines have a specialized one-way valve in them. What is it called and why is there/what does it prevent?
A
- Groshong Valve
- negates need for heparinization/prevents clots forming in line
23
Q
T or F: The PICC line is surgically inserted
A
F, it is not
24
Q
How is the PICC line held in place ?
A
Sutures
Manufactured Securement Device
25
Where is the IVAD inserted ?
Chest, Abdomen, Inner aspect of arm
| Subclavian/Jugular Vein are most common
26
Are IVAD's used for LT or ST ?
Long-term Therapy
27
T or F: IVAD's are surgically inserted
True
28
Where is the IVAD attached to on the body ?
attached to a reservoir in the subcutaneous pocket above the vein
29
How lumens can the IVAD have ?
none
30
How do you access the IVAD ?
with a special non-coring needle using sterile technique
31
What is an example of an IVAD ?
Port-a-cath
32
What are some CVAD assessments (5)?
Assess for redness, swelling, drainage, discomfort
Check the connections are secure
Assess dressing (dry & occlusive)
Measure external segment and compare with care plan on insertion
33
What do you use to flush a PICC line ?
Preservative-free NS in pre-filled syringes
34
When should you flush a PICC line ?
```
Routine care
Pre/Post Med Admin
Blood draw
Between incompatible medication admin
**as per the care plan
```
35
What volume syringe do you use to flush a PICC line?
10ml syringe or greater
36
How do you flush a PICC line ?
| **two (2) common techniques**
1. Push-Pause method
| 2. end with positive pressure
37
What do you do if you flush one lumen with a CVAD ?
FLUSH ALL
38
What are the steps in changing an Injection Cap on a PICC/CVC ?
- Assess need to change
- Adhere to care plan
- Prepare a new injection cap (prime and maintain asepsis)
- Ensure all clamps are engaged
- Instruct patient to perform Valsalva maneuver during cap change
- Flush
39
What are the steps in drawing blood from a PICC/CVC for blood withdrawal ? (not blood culture)
- Stop infusion (if running) 5 minutes prior
- Scrub cap for 15 seconds
- Flush 5ml of NS and withdrawal 6 ml of blood (discard)
- Scrub cap for 15 seconds
- Attach a new (empty) 10 ml syringe and draw desired amount of blood for testing
- Scrub cap for 15 seconds
- Flush post draw with 20ml of NS
40
What are the steps in drawing blood from a PICC/CVC for blood culture ? (not blood withdrawal)
- Stop infusion (if running) 5 minutes prior
- Aseptically prime a new cap with 10ml syringe (keep it attached
- Clamp lumen (if applicable) and take off cap
- Scrub port for 15 seconds (not the top of port, only the sides)
- Attach empty 10ml syringe to the now cap-less port
* *DO NOT ASPIRATE OR DISCARD BLOOD**
- unclamp line (if applicable)
- Aspirate amount of blood required for culture
- clamp line (if applicable)
- remove blood filled syringe
- Scrub port for 15 seconds
- Attach primed cap with 10ml syringe
- Flush line with 2 x 10ml syringes
- Flush one; Flush all (10ml NS)
41
What are the complications for CVAD's (12)?
- Occlusions
- Infection/Sepsis
- Phlebitis
- Venous Thrombosis
- Catheter migration
- Catheter fracture
- Air embolus
- Skin erosion
- Hematoma
- Infiltration/Extravasation
- Pneumothorax/Hemothorax/Hydrothorax
- Incorrect placement
42
What are the 3 ways catheter dysfunction can cause occlusions in CVAD's ?
Mechanical occlusion
Chemical occlusion
Thrombotic occlusion
43
What are the 3 types of catheter occlusions ?
Partial occlusion
Withdrawal occlusion
Complete occlusion
44
What are mechanical occlusions ?
internal or external problems with the catheter itself
45
What are chemical occlusions ?
medication or drug precipitate formed in catheter
46
What is a thrombotic occlusion ?
coagulation of blood in the CVAD line or around the CVAD vein creating a thrombus
47
What is a partial occlusion ?
resistance on flushing and aspiration with sluggish flow and blood return
48
What is a withdrawal occlusion ?
inability to aspirate blood without resistance
49
What is a complete occlusion ?
inability to infuse any fluids or aspirate blood
50
What are some patient related risk factors for Infection & Sepsis with CVAD's (10) ?
1. Immune suppressed
2. Neutropenia
3. Poor nutrition
4. Renal failure
5. Chronic infection
6. Diabetes
7. Short-bowel syndrome
8. Self-care deficit
9. Poor hygiene
10. inability to manage own care
51
What are some institutional related risk factors for Infection & Sepsis with CVAD's ?
1. Lack of hand hygiene
2. Lack of aseptic technique
3. Catheter material
4. Increased number of lumens
5. Inadequate port scrubbing
6. Poor maintenance & care
7. Improper flushing
8. Not changing wet dressings
9. Blocked/occluded lumens left un treated
10. Catheters in-situ when they shouldn't be
11. Sludge accumulation within lumen or needleless port
52
What is biofilm ?
a biologically active and bacterial sustaining coating that forms on the interior and exterior of CVAD's
53
If a patient has a BSI, What treatment must be done before they get a new CVAD ?
antibiotic treatment 24 - 48 hours prior to insertion
54
What is the definition of Phlebitis ?
inflammation of one or all three layers of the vein wall
55
What are the 3 categories of Phlebitis ?
1. Mechanical
2. Chemical
3. Bacterial
56
PICC lines are most likely to be affected by what kind of phlebitis & why ?
Mechanical
| - insertion site (trying to move along smaller veins and movement of upper arm muscles)
57
What is a Venous Thrombosis ?
the result of a normal physiological response to a foreign body entering the vein which leads to the aggregation of platelets and the accumulation of fibrin
58
Why is a Venous Thrombus a severe complication ?
The thrombus are formed outside of the CVAD, putting pressure on the vein, restricting bloodflow
59
What is Virchow's Triad ?
| What are the components of Virchow's Triad ?
- 3 factors affecting the development of a thrombus
| - Vessel wall damage/injury; Altered bloodflow; Hypercoagulation
60
Describe each component of Virchow's Triad and give examples (3) ?
1. Vessel wall damage:
- Trauma from CVAD insertion
- Friction from CVAD movement in vein
- Irritating solutions
2. Alteration in bloodflow:
- Venous stasis d/t immobility
- Obstruction of veins
- Compression of veins
- Heart failure
3. Hypercoagulation:
- Decreased coagulation factors
- Pregnancy
- Malignancy
- Post-op states
61
What are the manifestations of a Venous Thrombosis ?
- Edema of hand; arm; shoulder; neck on side of cath
- Distended jugular veins
- Appearance of dilated co-lateral veins over chest; upper arm; abdomen
- Pain around catheter insertion site
- Difficult breathing
- Discolouration of the skin in upper body
- Cyanosis of the hand and arm
62
How do you treat a Venous Thrombosis ?
- Contact physician and inform about S&S
- A venogram/US
- Anticoagulation therapy
- Remove line
63
What constitutes Catheter Migration ?
The internal tip of catheter moves its position with/without external movement
64
What can Catheter Migration cause ?
infusion of fluids to go against the direction of bloodflow
65
Why are NT-CVC's at a lesser risk of Catheter Migration ?
Catheters are stiff & large
66
What could cause a Catheter to Migrate ?
- Vomiting
- Sneezing
- Coughing
- Heavy Lifting
- HF
- Present tumours
- Mechanical ventilation
- Securement dressing or device is not intact (wet/loose)
67
What are the S&S of Catheter Migration ?
- External segments moves > 5cm
- Leaking of fluid at insertion site
- Swelling/redness/pain in chest or at insertion site
- Patients hears a swishing or flushing sound in their ear as the line is flushed
- Inability to flush or aspirate the line
- Arrhythmias
- Visible coiling of catheter in vein
68
What is a Catheter Fracture ?
a break or tear in the catheter
69
What can cause a Catheter Fracture ?
Forceful flushing
Pinch-off syndrome
accidental cutting of catheter
70
What is an Air Embolus ?
presence of air in the circulatory system that creates an intra-cardiac air lock at the pulmonic valve
71
What causes an Air Embolus ?
- Catheter Fracture
- Not applying clamps when removing needle-free caps
- Not covering the exit site with appropriate dressings
72
What are the S&S of an Air Embolus ?
- Hypoxia
- Rapid onset of SOB
- Coughing
- Anxiety
- Hypotension
- Cyanosis
- Palpitations or arrhythmia's
- Weak, rapid pulses
- Chest and shoulder pain
- LOC
73
What is Infiltration ?
Misdirection of IV fluid or med from the vein into the interstitial tissue
74
What is Extravasation ?
The inadvertent infiltration of a irritant/vesicant solution or med into surrounding tissues
75
What is an irritant drug ?
a drug or solution with the pH value of <5 or >9
OR
an osmolarity of >500mOsmol/L
76
What is a vesicant drug ?
a drug or solution that has the potential to cause blisters and tissue injury
77
What are the manifestations of Infiltration & Extravasation ?
- Erythema
- Edema
- Spongy feeling
- Swelling around IV site and at Catheter tip
- Increased WOB
- Aspiration of fluid/blood
- Pain with infusion of meds/solutions
78
What are some Advantages to IV med admin ?
- Quick therapeutic effect
- When meds are too irritant for other med routes
- Better control of how much you control of the med
79
What are some Disadvantages to IV med admin ?
- Rapid and severe reaction to med
- Fluid overload
- IV site complication
- Allergic reaction
- Speed Shock
80
What are the three prodromal manifestations of Anaphylaxis with IV med admin ?
1. Anxiety
2. Uneasiness
3. Impending doom
81
What are the 5 early signs associated with the integument system with Anaphylaxis in IV med admin ?
1. Erythema
2. Urticaria
3. Pruritus
4. Angioedema (eyelids, lips, tongue)
5. Feeling of warmth
82
What are the 5 early signs associated with the respiratory system with Anaphylaxis in IV med admin ?
1. "Lump in throat"
2. Hoarseness
3. Coughing or sneezing
4. Dyspnea
5. Stridor
83
What are the Late S&S of anaphylaxis in IV med admin ?
* *2 RESP
* *7 CARDIO
* * 4 GI
```
RESP
1. No breathing (obstruction)
2. Laryngeal spasms/edema
CARDIO
1. Hypotension
2. Fluid shift
3. Tachycardia
4. Bradycardia
5. Ischemia d/t vascular dilation
6. Cardiac arrest
7. Coma
GI
1. Nausea
2. Vomiting
3. Cramps
4. Diarrhea
```
84
How can you prevent Anaphylaxis in IV med admin ?
- Avoidance
- Screening for allergies
- Drug awareness & antidote
- Appropriate documentation
- Teaching
- Diligent checking on pt
- Thorough questioning
- Frequent assessment for early detection
85
How do you manage Anaphylaxis in IV med admin ?
- Remove allergen/STOP infusion
- Stay with pt
- Call for help/Call a code
- Apply O2
- Vitals ASAP --> Assess ABCDE
- Keep Vein open
- Provide emotional support
86
What is Speed Shock ?
Medication administered too quickly
87
Can Speed Shock happen with both IV direct and Intermittent IV admin ?
Yes
88
What are your nursing assessments for someone who is experiencing Speed Shock ?
- Dizziness
- Facial Flushing
- Headaches
- Irregular Heart Rate
- Sudden onset of symptoms associated with Med admin
89
How do you prevent Speed Shock ?
- Infuse @ correct rate
| - Use infusion devices if applicable
90
How do you treat Speed Shock ?
- Stop infusion immediately
- Maintain vascular access
- Contact physician
- Provide supportive care
- Monitor vitals closely
91
What does CATS PRRR represent and what is it used for ?
- Compatibility
- Allergies
- Tubing
- Site
- Pump
- Rate
- Release clamps
- Return and Reassess
* ** CATS PRRR is used for IV med admin and assessment
92
What are some indications for IV Insulin ?
- Emergency treatment for Diabetic Coma
- Diabetic Ketoacidosis (DKA)
- Hyperkalemia
- Hyperosmolar Hyperglycemic State (HHS)
- Hyperglycemia during critical illness
- Insulin dependant diabetic patients --> Surgery
- Dose finding strategy before converting patients to SC insulin
93
What are the S&S of HYPERglycemia ?
- Very Thirsty
- Dry Skin
- Sleepy
- Hungry
- Blurry Vision
- Slow Healing
- Frequent Urination
94
What are the S&S of HYPOglycemia ?
- Headachy
- Dizzy
- Grumpy
- Confused
- Hungry
- Sweaty
- Shaky
