IV and CVAD from coursepack

Question 1

how often do you flush IVs

Answer 1

q8-12hrs

Question 2

how to flush IV

Answer 2

swab w alcohol 15sec 3ml flush syringe-push pause (maybe aspirate) maint pos pressure w thumb on plunger for last0.5ml solution, close clamp, remove

Question 3

the primary infusion fx

Answer 3

for delivery of soln or for maint of vascular volume

Question 4

continuous infusion (iv soln at constant rate) can also be the ___

Answer 4

primary infusion

Question 5

what is intermittent infusion

Answer 5

iv soln admined at prescribed interval iv med may be delivered by pump or gravity drip at the approp rate. when the IV med is finished the tubing is disconnected and the IV access device is flushed

Question 6

IV piggyback is aka

Answer 6

aka secondary infusion IV soln or med attached to main set thats started concurrently or intermittently with the primary infusion

Question 7

IV bolus

Answer 7

Conc med or soln given over short time either IV direct or thru infusion set. Lookup monograph for specified timeframe over which to give soln

Question 8

IV direct

Answer 8

Admin of Ned via syringe over specific period of time >1min

Question 9

How to choose where to give IV direct message on tubing

Answer 9

If IV monograph says “direct into IV tubing” can give via syringe into lowest portfolio infusing IV or directly into cap of extension set. Decide via fluid status, potential for adverse run and risk of phlebitis.

Question 10

What can happen if give IV med too quick

Answer 10

Can result in death or other

Question 11

What is IV push

Answer 11

Rapid admin of bolus of Med via syringe

Question 12

When would IV push med be necessary

Answer 12

When rapid response is needed eg cpr

Question 13

What is kvo

Answer 13

Keeping vein open for future requirements of infusion May mean adding extension sets, caps or continuous infusion at low rate

Question 14

What must a kvo rate have

Answer 14

A drs order w specific rate

Question 15

What does checking for blood return confirm

Answer 15

If there’s blood return it shows patency but doesn’t confirm tip position. if theres no return it shows catheter malfunction & warrants assessment

Question 16

Are piccs and peripheral ivs both vads

Answer 16

Yes

Question 17

What do if can’t flush or aspirate peripheral IV

Answer 17

Remove

Question 18

• if a peripheral IV has some resistance when flushing what do
• what do if kinked
• what do if blood in tubing

Answer 18

• assess tubing for kinks etc
• check under drsg
• is catheter kinked at site? if yes and you can flush then apply drsg
• if theres no kink or blood at site then remove

Question 19

what size NaCl to use to flush CVAD

Answer 19

10ml minimum

Question 21

when to change drsg after initial CVAD insertion

Answer 21

24h after insertion

Question 22

how often to assess CVC

Answer 22

qshift

before access

after access

Question 23

what to document/assess for CVC

Answer 23

• site for redness, swelling, drainage
• connections secure
• drsg dry
• sutures intact
• measure external segment….
  
  • clamp unused lumens CHANGE POSITION OF CLAMPS DAILY TO PREVENT DAMAGE TO LUMEN

Question 24

if external segment of CVC moves more than __cm in adult or ___cm in kids what must be done

Answer 24

• >5cm in adult or >1cm in kid notify dr.
• xray must be done to confirm position

Question 25

transparent dressing change VIHA procedure * how often to change?

Answer 25

* drsg and cap 7 days and PRN * mp;ambpmad;ebknmakdbna;kbnak;bn;akdnb;pd nk bk; nk;n goc o

Question 26

how often to change gauze drsg CVC

Answer 26

q2 days and PRN

Question 27

CVC tubing change timing

Answer 27

* q96hrs if continuous infusion * q24hrs if intermittent use or TPN

Question 28

how to flush CVC

Answer 28

* aspirate for blood before use to confirm patency * use 10ml NS pre and post medications * lock catheter w 3ml heparin lock soln

Question 29

what is nec for removal VIHA

Answer 29

dr order apply occlusive drsg (vaseline impregnated gauze, then gauze and transparent drsg to remain in place x24hr

Question 30

why use vaseline impregnated gauze after removal

Answer 30

to prevent air embolism and dec risk of infection

Question 31

what is ASASH

Answer 31

* aspirate * saline * admin med * saline * heparin

Question 32

if you have a capped lumen not in use how often to flush

Answer 32

q24h w ASASH

Question 33

what are the various coloured lumens for generally

Answer 33

* brown is distal (at tip of catheter)- * TPN, blood, CVP monitoring * blue is medial and exits 1'above distal site- * TPN, meds, general access, blood * proximal- * meds, general access

Question 34

how many saline syringes to bring if pt has 3 lumens

Answer 34

9. 3 for each. you should only use 2 for each lumen but if you aspirate blood into one you have to toss it....actually probably 12 because the procedure says to do 2 initial flushes one after another

Question 35

flush technique in general

Answer 35

turbulent flush (this is forceful)

Question 36

flush CVC procedure for in use line

Answer 36

* CLEANSE 30sec. let dry * aspirate. discard if gets into syringe * fush w 10ml NS. CLAMP AND REMOVE. * flush w 10ml NS. Clamp. * CLEANSE * med * CLEANSE * heparin and end w positive pressure * clamp

Question 37

how to flush capped lumen not in use

Question 38

solution bag change

Answer 38

* label admin set w date to be changed and apply below chamber * attach bag to tubing and purge tubing of air * label w pt name, date, flow rate, nurse initials, and time * place sterile cap on end of tubing * assess site * stop infusions and close clamp * put on gloves * MAKE SURE CLAMP IS CLOSED ON LUMEN TO BE CHANGED * cleanse tubing, connection * d/c admin set and attach new primed set * open clamp. re establish infusion

Question 39

what to label soln for CVAD with

Answer 39

label w pt name, date, flow rate, nurse initials, and time

Question 40

s/s of catheter migration

Answer 40

* catheter measurement of +/-5cm from insertion record * pt hears gurgling sound in ear on catheter insertion side * pain in chest, shoulder, back * catheter occlusion (indicated by lack of blood return, resistance during injection, alterations in gravity flow rate. may be partial or complete occlusion)

Question 41

first instructions to pt w no blood return from CVC what if theres still no blood return but you can flush

Answer 41

* take deep breath and cough * raise and lower arms * change position * ask pt to repeat above * if still no blood return * flush w 20ml NS * get drs order

Question 42

youve already flushed w 30ml and theres still no blood return what will happen with the drs order

Answer 42

drs order * admin de-clotting agent as per protocol * may need to repeat * may need to confirm placement * if none of this indicates patency then dr will want to remove