IV therapy test 3 Flashcards by Deondra Watson

Shorter Cath 
Sterile 
subclavian to Superior Vena Cava /internal/external Jugular
or femoral vein to Inferior Vena cava 
Shorter term use
Right Side

Centrally inserted catheters

Regular central line

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longer catheter
Sterile 
AC(median), basilica or cephalic of upper arm into Superior Vena Cava 
Longer Term
Home care

Peripherally inserted central catheter PICC

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Subcutaneous implanted device 
advantages of central lines with out Cath exposed outside the skin 
Medi-port, Infus-a-port, Port-a-cath 
Superior vena Cava via subclavian 
Sterile
Special hook or L shaped needle (Huber)

Centrally implanted ports

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the path to the SVC is less torturous and associated with lesser chance of tension pneumothorax that from left side

the right side placement is best in central catheters

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in the position of a central or peripheral line they should

terminate in the superior vena cava within 3-4 cm of the junction of the superior vena cava with the Right Atrium

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where should the terminal line terminate

in the inferior vena cava

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what must be done to confirm placement before using a peripheral or central line

Xray

cant use until Doctor read and confirmed in the right place and is ready to use

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can happen during insertion, tubing change or removal

air embolism

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puncture of an artery by the needle or guide wire during insertion

Arterial Laceration

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d/t perforation of the pericardium by Catheter

cardiac tamponade

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breakage of a portion of the Central venous Cath

Catheter embolism

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dislodgment outside the superior vena cava

catheter malposition

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blood or air accumulation in the pleural cavity d/t perforation of the pleura or vessel laceration during insertion

hemothorax or pneumothorax

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to the cervical and upper dorsal spinal nerves that supply the arms and hands

Nerve injury

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An air embolism is a __ major complication

Preventable

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a central or peripheral catheter shouldn’t rest In the Right Atrium as it could traverse the SA node and cause ___ or become entrapped in the ___ valve and cause valvular damage that may require replacement surgery

dysrhythmias

tricuspid

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in Air bolus effect a ___ ml/sec influx, breach in a ___ g Central venous Catheter in a client sitting in a ___ position. The bolus of air proceeds to the __ where it lodges against the ___ valve and blocks ___ blood flow

100
14
upright 
heart 
pulmonic 
pulmonary

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The treatment for air bolus effect is

immediately Left trendelenburg position 
clamp central venous catheter 
02@ 100% 
monitor VS 
Call physician

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prior to the insertion of the central venous catheter the client should be instructed to perform the ___ to reduce the risk of an air embolism

valsalva maneuver (gotta shit)

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Lumens are usually __ coded, with __ and __ stated on the line

color
name
size

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this port is used in high volume or viscous fluids, medications. Its the largest lumen and close to the heart

Distal port

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this port is used for blood sampling

proximal port

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Reserved exclusively for TPN

If TPN Isn’t used may deliver meds through this port

Medial Port

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this port should be used for fluids or medications

fourth lumen

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Each lumen should be ___ according to its ___ use.

labeled | intended

CDC recommends at least __ changes to the dressing and replacement of the dressing if it becomes __, __, __, __or if inspection of the site requires removal of the dressing

``` weekly soiled damp wet loosened ```

Long term complications are often the result of __ catheter care or the clients ___ situation

inadequate | clinical

With catheter site management clean skin is to be disinfected using ___, preferably, or tincture of ___ or ___ and allowed to air dry

chlorhexidine iodine 70% alcohol

One of the most important mechanisms used to maintain the latency of the central line and prevent occlusion

flushing/irrigating a Central Venous Catheter

during flushing or irrigating if resistance is felt __ irritant into the vessel, results in thrombus embolism

never force

With flushing and irrigation of a central venous catheter never use less than a ___ ml syringe to irrigate, smaller barrel syringe generate more ___ that larger ones

10 | pressure

What type of method do we use other than continuous pressure

push pause method

when locking the line it must be ___ to maintain patency if not in use which prevent __ formation; its done every __ hours for canals not in use.

heparinized thrombus 8-12

When drawing blood from the Central Venous catheter infusates need to be turned __ for ___ before drawing blood for ___ or ___

off 1 full minute glucose electrolytes

blood draws should be done from the ___

proximal port

If an infusion has been running, after the infusion is stopped for ___ full minute, the line is flushed with __ ml NS using Push pause method ___ ml of blood is drawn from the line and ___

1 10 5-10 discarded

A soft medical grade silicon catheter with a __ near the exit site that __ it in place and acts as a securing device and __

Cuff Anchors Microbial barrier

The proximal end of the catheter is __ in the ___ tissue to an exit site on the anterior or posterior trunk of the body

Tunneled | Subcutaneous

The central venous tunneled catheters care is a __, except that there are ___ to care for. methods of __, ___. Are the same as for non-tunneled Central venous catheters

Central line Skin incisions Flushing Heparinizing

The brands of central venous tunneled catheters

Broviac Hickman Leonard Groshong

Piccs are used for administration of

Fluids Blood Meds

A picc line can stay in place for __ weeks or a __, to be __ effective; therapy should be required for ATLEAST __ days

1-12 Year Cost 7

Picc lines are used for ___ sampling, ____ and ___ administration

Blood Chemotherapy TPN

Risks with the picc lines are arm __ d/T limited __, bleeding normal within the first ___ hrs of placement, ___, infusion pain, ____, fluid leakage, catheter malposition, catheter occlusion, stuck catheter

``` Edema ROM 24 Phlebitis Thrombophlebitis ```

Picc dressings changes are done usually every __ days or __ when the dressing is __, ___ or ___.

``` 7 PRN Loose Wet No occlusive ```

Flushing of the picc line is done with ___, followed by ___ based on policy

0.9% NS | Heparin

Subcutaneously implanted advantages are that the port is palpated under the skin. Under sterile technique, the port is accessed. ___ is applied, a ___ needle is used to access the port, inserted at a __ angle (L shaped) the port is flushed and blood withdrawn to confirm __ dressing is ___

``` Betadine Huber 90 Patency Tegaderm ```

Formally known as hyperalimentation, also known as center As parenteral nutrition

Total parenteral nutrition TPN

Typical indications for TPN

``` Bowel surgery Bowel rest Pancreatitis IBD OBSTRUCTION chronic weight loss Coma Hepatic or renal failure Malnutrition Multiple trauma ```

The TPN solution is patient ___, taking into consideration ___ and ___ status, stress factors and renal competency

Specific | Nutritional metabolic

TPN can be administered ___ or ___; bulk of TPN given durning __ and __ hours, remainder of nutrients given Orally in the ___

``` continually cyclically evening night day ```

TPN solution usually contains ___ (amino acids), sugar (___10%-70%), ___ = ___ solution that usual IVF's

protein dextrose lipids thicker

TPN solutions can include other substances like ___, ___, ___ and trace ___.

electrolytes, minerals, vitamins, elements

TPN can only be given in the ___

medial port

Nurse administering TPN is responsible for reviewing the clients

``` weight height nutritional status diagnosis current lab values prior ```

Rapid infusion of hypertonic dextrose may result in ___, ___, ___or a ___ coma

diuresis hyperglycemia glycosuria hypersomolar

TPN lipid containing solutions (3-1) must complete the infusion within ___ of hanging; The lipid ONLY infusion must be complete within ___ of hanging (___ hours if volumes require longer time)

24 12 24

If Breaking out or oiling out - separation and yellowish streaking or accumulation of yellow droplets in the emulsion occur what must the nurse do

Do not administer and discard | send back to pharmacy and request another

With lipids you DO NOT use ___, because fat molecules are too large to pass through

Filters

The initial rate of administration of TPN should be ___ for he first __ minutes. Then increase to ___. No more than ___ should be administered to an adult in the first ___ of therapy. Thereafter rate should not exceed ___

``` 1ml/min 15-30 2ml/min 500ml 24 2.5G/kg/day ```

Should the infusion of TPN get behind schedule DO NOT __ causes ___ and ___

speed up to catch up hyperglycemia metabolic complications

when administering TPN use an ___ using a special ___, monitor fusion every ___, vital signs q __ and ___, obtain daily __ with strict ___

``` infusion pump filter 30-60 minutes 4 PRN weight I&O's ```

When discontinuing TPN adequate oral intake must be assessed __ TPN can be stopped, ___ must occur to prevent ___; done over ___ period by gradually ___ the volume of TPN while monitoring Patient response

``` before weaning rebound hypoglycemia 24-48 hour decreasing ```

Method of giving diluted solutions of protein and calories in a peripheral IV site is ___, consists of nutritional support of __ and ___ and ___ lipid content, either given with the __ and ___ or ___

``` PPN Peripheral Parenteral Nutriton amino acids dextrose 10-20% protein sugar separately ```

PPN are used for stable clients who's GI feedings will be ___, its used for persons who have __ intake but refuse an ___ feeding tube

reestablished quickly poor Enteral

PPN is mildly ___ 10% dextrose and can be administered via a large ___ vein rather than a central ___. Short term therapy lasting less than __ weeks usually __ days

``` hypertonic peripheral vessel 3-4 5-14 ```

Documentation includes ___ of Parenteral nutrition solution, ___ and ___ for infusion, Site ___ before and ___ infusion ___ of the catheter __ before, ___, and after infusion, all __ used, ___ and ___ of tubing ___ , any ___ or ___ or ___ experienced before, during or after the infusion and any action used to ___ problem, daily ___ and accurate ___, all client and caregiver ___ and ___ teachings

components, infusion rate, equipment used, assessment during, observations, patency, during, supplies, date, time changes, complaints, discomforts symptoms correct/address weight/ IO's education, discharge

The electrolyte imbalances that are common with Parenteral infusions are

K P MG

indications for long term IV therapy central lines

Picc line most preferred line

basilic

central line, flushing what size syringe

10cc

how do you flush

push pause

why is it important for tip not to go into right atrium or tricuspid valve

dysrhythmias

to prevent a air embolism when we manipulate central line

bear down

access in femoral vein tip lies

inferior venacava

central line dressing change

7 days

reduce risk of air embolism what position

supine

subcutaneous implant ports

under the skin, nothing exposed when not in use, access with huber needle

3 lumens

distal - meds, fluids medial -TPN proximal - blood

why need blood

hemorrhage anemia replacement

IV therapy test 3 Flashcards

(80 cards)