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Complex Care > IV, CVC, CT > Flashcards

IV, CVC, CT Flashcards

1
Q

When is the IV push route used?

A

in emergencies or whenever an immediate drug effect is needed

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2
Q

What can you not administer IV push with?

A
  1. parenteral nutrition
  2. continuous medication infusion
  3. blood
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3
Q

Explain the technique for administering IVP through a Y site when the medication is compatible with the IV solution

A
  1. select port closest to patient
  2. scrub
  3. attach medication
  4. occlude IV by pinching just above port
  5. inject
  6. flush
  7. verify continuous infusion rate
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4
Q

Explain the technique for administering IVP through a Y site when the medication is not compatible with the IV solution

A
  1. select port closet to patient
  2. swab
  3. stop infusion
  4. swab
  5. 10ml NS flush
  6. inject
  7. swab
  8. 10ml NS flush
  9. re-establish infusion
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5
Q

Explain the technique for administering IVP through SL

A
  1. scrub, allow dry
  2. 3ml NS flush
  3. scrub, allow dry
  4. attach med and inject
  5. scrub
  6. 3 ml NS flush
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6
Q

Explain the rate you would administer a push medication ordered over 3 minutes?

A

Dilute in 10ml
3.3ml/min
Just over 1ml/20 sec

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7
Q

Symptoms of speed shock

A
  • flushed face
  • Headache
  • a tight feeling in the chest
  • irregular pulse
  • loss of consciousness, and
  • cardiac arrest
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8
Q

Signs and symptoms of infiltration

A

blanching, edema, coolness and pain or numbness

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9
Q

Treatment of infiltration

A
  1. stop infusion
  2. pull IV
  3. warm compress
  4. if medication was infusing, call MD
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10
Q

Treatment of extravasation

A
  1. stop infusion
  2. pull IV
  3. warm compress
  4. elevate limb
  5. notify MD
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11
Q

When is an isotonic solution given + list 3 examples

A

to increase blood volume without moving solvent out of veins into tissue (NS, LR, D5W)

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12
Q

When is a hypotonic solution given and given an example

A

given when we need to put fluid into the cells (0.45NS)

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13
Q

When is a hypertonic solution given and give 2 examples

A

given when we need to put fluid intravascularly (5% NS, D10W)

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14
Q

Define Pneumothorax

A

Accumulation of air in the pleural cavity that leads to partial or complete lung collapse
Can be a:
1. Pneumothorax - air
2. Hemothorax - blood

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15
Q

Define pleural effusion

A

Fluid in lung

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16
Q

Where is a chest tube inserted to drain air and why?

A

placed anteriorly through the 2nd intercostal space; placed higher up because air rises

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17
Q

Where is a chest tube placed to drain fluid and blood and why?

A

placed posteriorly through the 8th or 9th intercostal space; placed lower because they fall with gravity

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18
Q

Most common chest tube type

A

Large bore

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19
Q

What are the 3 possibilities of devices a chest tube would be attached to to assist in drainage?

A
  1. suction
  2. water seal
  3. passive drainage
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20
Q

Describe a wet chest tube drainage system

A

disposable, self contained system

the fluid level in the third chamber is prescribed by surgeon and chamber is connected to wall suction

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21
Q

Describe a dry chest tube drainage system

A

disposable self contained system

the prescribed suction is dialled on device

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22
Q

How much fluid is expected to drain from a pleural chest tube in the first 3 hours post insertion?

A

100-300ml

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23
Q

What is the 24 hours fluid drainage rate from a chest tube?

A

500-1000ml

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24
Q

What is the atrium/oasis chest drain classified as?

A

Dry Suction Water Seal System

(standard one we will see in hospital)

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25
Q

What is the suction regulation on the atrium/oasis chest drain?

A

Top left corner

Regulates suction - Standard order 20cm

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26
Q

What are the 2 purposes of the water seal chamber?

A

prevents air from entering the chest while allowing air in the chest cavity to escape

see if the water level is moving - this is tidaling (some is expected as patient breaths in and out

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27
Q

What do irregular air bubbles in the drainage system indicate?

A

Air from chest cavity; what you want to see

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28
Q

What volume of drainage in a chest tube system in an hour would be present for you to alert the MRP?

A

> 100ml/hr

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29
Q

What part of the drainage system shows you the suction device is providing the same amount of suction indicated on the regulator?

A

The suction monitor bellows; orange piece should extend to triangle mark

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30
Q

What are the 6 main things nurses monitor/care for regarding chest tubes?

A
  1. leaks
  2. drainage
  3. kinks
  4. below level of insertion
  5. tidaling
  6. bubbling
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31
Q

What is the main role of an RN in chest tubes?

A

Maintain and care

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32
Q

True or false: the suction amount on the CT drainage device must be ordered

A

True

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33
Q

How are CT drainage units to be positioned?

A

below the level of the chest in an upright position with tubing in non dependent loops on the bed

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34
Q

What must be present on all connections between patient and drainage unit?

A

waterproof tape or tip ties

35
Q

What must be located at the bedside of a patient with a CT and why?

A
  1. Bottle of sterile water
    > in case of accidental disconnection to maintain water seal
  2. 2 clamps
    > in case of accidental disconnection for cross clamping
36
Q

For what reason would a nurse clamp a chest tube (for <1min)

A
  1. to change drainage unit
  2. to locate an air leak
  3. to assess bubbling/tidaling
37
Q

How is the readiness for a CT removal assessed?

A

Clamped per doctors order

38
Q

What are the main assessments of a patient with a chest tube?

A

Focussed respiratory and insertin site

39
Q

What are you assessing for at a CT insertion site?

A
  1. d + i dressing (reinforce as needed)
  2. occlusive dressing if air leaf
  3. excessive bleeding
  4. subcutaneous emphysema
40
Q

What interventions should be encouraged for a patient with a chest tube?

A

DB&C, incentive spirometer, ambulation if able

41
Q

An obstructed/displaced chest tube is a common cause of a:

A

tension pneumothorax

42
Q

what is a tension pneumothorax

A

results when air is trapped in pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Medical emergency.

43
Q

What are the 4 complications related to chest tubes?

A
  1. displacement
  2. infection at site
  3. pneumonia
  4. shoulder disuse
44
Q

What is needed for each external lumen on CVC and which line type is the exception?

A

a clamp is supplied for each external lumen on most CVCs, except for valved PICCs which do not require clamps

45
Q

What 3 reasons would a patient need a central line?

A
  1. frequent access
  2. medications that are hard on the veins
  3. many access ports are needed
46
Q

Explain the placement of a PICC

A

usually in the basilic or cephalic vein and threaded through the subclavian vein into the superior vena cava

above/below antecubital fossa

47
Q

How does the lumen size of a PICC compare to CVC

A

Smaller, limits use for fluid resuscitation/blood withdrawal

48
Q

True or False: PICCs are always sutured in

A

False, but will have securing device

49
Q

PICC catheters with a built in valve do not require:

A

clamps

50
Q

If mechanical phlebitis is observed in the first week after PICC insertion, what must occur?

A

Mechanical phlebitis may be observed in the first week after insertion - the catheter may still be used and usually does not need to be removed

51
Q

What type of central line is most susceptible to kinks/damage?

A

PICC

52
Q

What type of central line has the lowest risk of infection and air embolism?

A

PICC

53
Q

What may occur as a result of the length of the catheter during PICC removal

A

Venous spasm may cause resistance to removal

54
Q

What nursing interventions should never occur on an arm with a PICC?

A

BP and blood draw

55
Q

A nontunneled central venous catheter is also known as:

A

Short Term CVC

56
Q

What veins is a Nontunneled Central Venous Catheter - Short Term CVC inserted into?

A

internal jugular or subclavian

57
Q

When is a Nontunneled Central Venous Catheter - Short Term CVC most commonly used?

A

emergency/trauma

58
Q

How is a Nontunneled Central Venous Catheter - Short Term CVC secured

A

Suture wings

59
Q

What must occur before the use of Nontunneled Central Venous Catheter - Short Term CVC

A

confirmation of placement with CXR

60
Q

What central line has greatest risk of complications at insertion?

A

Nontunneled Central Venous Catheter - Short Term CVC

61
Q

What central line is not used outside of the hospital r/t risk of accidental removal?

A

Nontunneled Central Venous Catheter - Short Term CVC

62
Q

What central line has highest risk of infection?

A

Nontunneled Central Venous Catheter - Short Term CVC

63
Q

A tunneled catheter is also known as:

A

Long term CVC

64
Q

What is unique about the catheter of a long term CVC?

A

Has a cuff that tissue grows int to prevent movement of the CVC

Cuffs can have antibiotics in them

65
Q

What are the special considerations of implanted ports?

A
  1. require heparin flush
  2. patient ability to manage at home/special equipment
  3. surgical removal
66
Q

Describe the nurse management of central lines

A
  • site assessment
  • dressing changes
  • medication administration
  • blood withdrawal
  • d/c as soon as possible
67
Q

Describe the site assessment of a central line

A

skin: redness, swelling, leakage, phlebitis
infection: signs and symptoms
length of device r/t migration
security of dressing, sutures, securement device
damage

68
Q

How often are transparent, semipermeable CL dressings changed?

A

5-7 days or PRN (soiled, wet, non-occlusive)

69
Q

How often are gauze around CL changed?

A

Every 2 days

70
Q

How often are tubing and extension sets changes on CL?

A

every 96 hours

71
Q

Describe the assessment of function of a CVC/PICC

A

Function is assessed aspirate for blood return and flush prior to each use

72
Q

What type of connection is used for continuous infusions on CL?

A

Direct luer lock

73
Q

How are intermittent medications administered on CL?

A

needleless adapter/injection port

74
Q

Describe the technique for flushing PICCS and when must occur

A

Flushed with 10ml NS using a start and stop method

  • after blood withdrawal
  • after blood admin
  • before and after each med admin
  • maintenance of an unused lumen
75
Q

True or false: blood can be withdrawn from any lumen on a central line

A

False: not one
- dedicated to parenteral nutrition
- one from which drug levels must be drawn

76
Q

What must you do before drawing blood specimens from a CVC?

A

discard a volume of blood

77
Q

If IV infusions are running through a CL, what must you do before withdrawing blood?

A

Turn off all infusions for 1-2 minutes

78
Q

What are the 3 steps to the syringe method for withdrawing blood?

A
  1. aspirate, pull back 1 ml, and pause for 1-2 seconds
  2. hold continuous pressure to prevent frothing/hemolysis which would effect lab results
  3. never use needle to transfer blood from a syringe to a blood tube, always use blood transfer device
78
Q

What must you do immediately following blood withdrawal from a central line

A

Lumen must be flushed immediately following sampling using turbulent flow/start and stop method

79
Q

Describe the technique for removing a CVC and rationale behind it

A

Remove on exhalation because intrathoracic pressure is increased during exhalation and will reduce risk of air embolism on removal

  • Apply pressure for 5 minutes (no peaking)
  • Lie flat for 30 minutes following
  • Apply occlusive dressing (bandaid). Assess intactness of tip. Document.
80
Q

Describe the technique for removing a PICC

A

extend arm out at 90 degree angle and do not manipulate arm above site to prevent vasospasm

81
Q

What can you do to prevent air embolism in CL?

A

Exhalation on removal

81
Q

What should you do if you feel resistance when removing a PICC?

A

reposition arm and reattempt removal. Secure PICC with tape for gentle traction and attempt again in 3 minutes; sometimes necessary to wait 12-24 hours for vasospasm to decrease

82
Q

How can you prevent catheter occlusions on CL?

A

fibrin develops at end of catheter and plugs the line; following flushing protocols!!

Complex Care (9 decks)

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