IV, CVC, CT Flashcards
(84 cards)
1
Q
When is the IV push route used?
A
in emergencies or whenever an immediate drug effect is needed
2
Q
What can you not administer IV push with?
A
- parenteral nutrition
- continuous medication infusion
- blood
3
Q
Explain the technique for administering IVP through a Y site when the medication is compatible with the IV solution
A
- select port closest to patient
- scrub
- attach medication
- occlude IV by pinching just above port
- inject
- flush
- verify continuous infusion rate
4
Q
Explain the technique for administering IVP through a Y site when the medication is not compatible with the IV solution
A
- select port closet to patient
- swab
- stop infusion
- swab
- 10ml NS flush
- inject
- swab
- 10ml NS flush
- re-establish infusion
5
Q
Explain the technique for administering IVP through SL
A
- scrub, allow dry
- 3ml NS flush
- scrub, allow dry
- attach med and inject
- scrub
- 3 ml NS flush
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
7
Q
Symptoms of speed shock
A
- flushed face
- Headache
- a tight feeling in the chest
- irregular pulse
- loss of consciousness, and
- cardiac arrest
8
Q
Signs and symptoms of infiltration
A
blanching, edema, coolness and pain or numbness
9
Q
Treatment of infiltration
A
- stop infusion
- pull IV
- warm compress
- if medication was infusing, call MD
10
Q
Treatment of extravasation
A
- stop infusion
- pull IV
- warm compress
- elevate limb
- notify MD
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)
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)
13
Q
When is a hypertonic solution given and give 2 examples
A
given when we need to put fluid intravascularly (5% NS, D10W)
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
15
Q
Define pleural effusion
A
Fluid in lung
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
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
18
Q
Most common chest tube type
A
Large bore
19
Q
What are the 3 possibilities of devices a chest tube would be attached to to assist in drainage?
A
- suction
- water seal
- passive drainage
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
21
Q
Describe a dry chest tube drainage system
A
disposable self contained system
the prescribed suction is dialled on device
22
Q
How much fluid is expected to drain from a pleural chest tube in the first 3 hours post insertion?
A
100-300ml
23
Q
What is the 24 hours fluid drainage rate from a chest tube?
A
500-1000ml
24
Q
What is the atrium/oasis chest drain classified as?
A
Dry Suction Water Seal System
(standard one we will see in hospital)
25
What is the suction regulation on the atrium/oasis chest drain?
Top left corner
Regulates suction - Standard order 20cm
26
What are the 2 purposes of the water seal chamber?
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
27
What do irregular air bubbles in the drainage system indicate?
Air from chest cavity; what you want to see
28
What volume of drainage in a chest tube system in an hour would be present for you to alert the MRP?
>100ml/hr
29
What part of the drainage system shows you the suction device is providing the same amount of suction indicated on the regulator?
The suction monitor bellows; orange piece should extend to triangle mark
30
What are the 6 main things nurses monitor/care for regarding chest tubes?
1. leaks
2. drainage
3. kinks
4. below level of insertion
5. tidaling
6. bubbling
31
What is the main role of an RN in chest tubes?
Maintain and care
32
True or false: the suction amount on the CT drainage device must be ordered
True
33
How are CT drainage units to be positioned?
below the level of the chest in an upright position with tubing in non dependent loops on the bed
34
What must be present on all connections between patient and drainage unit?
waterproof tape or tip ties
35
What must be located at the bedside of a patient with a CT and why?
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
For what reason would a nurse clamp a chest tube (for <1min)
1. to change drainage unit
2. to locate an air leak
3. to assess bubbling/tidaling
37
How is the readiness for a CT removal assessed?
Clamped per doctors order
38
What are the main assessments of a patient with a chest tube?
Focussed respiratory and insertin site
39
What are you assessing for at a CT insertion site?
1. d + i dressing (reinforce as needed)
2. occlusive dressing if air leaf
3. excessive bleeding
4. subcutaneous emphysema
40
What interventions should be encouraged for a patient with a chest tube?
DB&C, incentive spirometer, ambulation if able
41
An obstructed/displaced chest tube is a common cause of a:
tension pneumothorax
42
what is a tension pneumothorax
results when air is trapped in pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Medical emergency.
43
What are the 4 complications related to chest tubes?
1. displacement
2. infection at site
3. pneumonia
4. shoulder disuse
44
What is needed for each external lumen on CVC and which line type is the exception?
a clamp is supplied for each external lumen on most CVCs, except for valved PICCs which do not require clamps
45
What 3 reasons would a patient need a central line?
1. frequent access
2. medications that are hard on the veins
3. many access ports are needed
46
Explain the placement of a PICC
usually in the basilic or cephalic vein and threaded through the subclavian vein into the superior vena cava
above/below antecubital fossa
47
How does the lumen size of a PICC compare to CVC
Smaller, limits use for fluid resuscitation/blood withdrawal
48
True or False: PICCs are always sutured in
False, but will have securing device
49
PICC catheters with a built in valve do not require:
clamps
50
If mechanical phlebitis is observed in the first week after PICC insertion, what must occur?
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
What type of central line is most susceptible to kinks/damage?
PICC
52
What type of central line has the lowest risk of infection and air embolism?
PICC
53
What may occur as a result of the length of the catheter during PICC removal
Venous spasm may cause resistance to removal
54
What nursing interventions should never occur on an arm with a PICC?
BP and blood draw
55
A nontunneled central venous catheter is also known as:
Short Term CVC
56
What veins is a Nontunneled Central Venous Catheter - Short Term CVC inserted into?
internal jugular or subclavian
57
When is a Nontunneled Central Venous Catheter - Short Term CVC most commonly used?
emergency/trauma
58
How is a Nontunneled Central Venous Catheter - Short Term CVC secured
Suture wings
59
What must occur before the use of Nontunneled Central Venous Catheter - Short Term CVC
confirmation of placement with CXR
60
What central line has greatest risk of complications at insertion?
Nontunneled Central Venous Catheter - Short Term CVC
61
What central line is not used outside of the hospital r/t risk of accidental removal?
Nontunneled Central Venous Catheter - Short Term CVC
62
What central line has highest risk of infection?
Nontunneled Central Venous Catheter - Short Term CVC
63
A tunneled catheter is also known as:
Long term CVC
64
What is unique about the catheter of a long term CVC?
Has a cuff that tissue grows int to prevent movement of the CVC
Cuffs can have antibiotics in them
65
What are the special considerations of implanted ports?
1. require heparin flush
2. patient ability to manage at home/special equipment
3. surgical removal
66
Describe the nurse management of central lines
- site assessment
- dressing changes
- medication administration
- blood withdrawal
- d/c as soon as possible
67
Describe the site assessment of a central line
skin: redness, swelling, leakage, phlebitis
infection: signs and symptoms
length of device r/t migration
security of dressing, sutures, securement device
damage
68
How often are transparent, semipermeable CL dressings changed?
5-7 days or PRN (soiled, wet, non-occlusive)
69
How often are gauze around CL changed?
Every 2 days
70
How often are tubing and extension sets changes on CL?
every 96 hours
71
Describe the assessment of function of a CVC/PICC
Function is assessed aspirate for blood return and flush prior to each use
72
What type of connection is used for continuous infusions on CL?
Direct luer lock
73
How are intermittent medications administered on CL?
needleless adapter/injection port
74
Describe the technique for flushing PICCS and when must occur
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
True or false: blood can be withdrawn from any lumen on a central line
False: not one
- dedicated to parenteral nutrition
- one from which drug levels must be drawn
76
What must you do before drawing blood specimens from a CVC?
discard a volume of blood
77
If IV infusions are running through a CL, what must you do before withdrawing blood?
Turn off all infusions for 1-2 minutes
78
What are the 3 steps to the syringe method for withdrawing blood?
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
What must you do immediately following blood withdrawal from a central line
Lumen must be flushed immediately following sampling using turbulent flow/start and stop method
79
Describe the technique for removing a CVC and rationale behind it
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
Describe the technique for removing a PICC
extend arm out at 90 degree angle and do not manipulate arm above site to prevent vasospasm
81
What can you do to prevent air embolism in CL?
Exhalation on removal
81
What should you do if you feel resistance when removing a PICC?
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
How can you prevent catheter occlusions on CL?
fibrin develops at end of catheter and plugs the line; following flushing protocols!!
