VADs and Blood Admin Flashcards

1
Q

What types of catheters are best for administering large volumes of fluid, PN, and other med ?

A

central vascular access devices (CVADs)
- long term use (chemo, PN)

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2
Q

What is a peripherally inserted central catheter (PICC) used for ?

A

peripherally inserted central catheter
- long term use (chemo, PN)

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3
Q

What is a peripheral catheter ?

A

for short term use
- after surgery or a procedure

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4
Q

How do you select a peripheral site ?

A
  • avoid starting IV site on extremity with dialysis graft
  • use distal veins prior to distal proximal veins
  • use non dominant arm
  • need order to use a site that isn’t the upper extremities
  • do not select sites on mastectomy side, dialysis, paralyzed
  • caution with hard veins, valves, skin bruising or other abnormalities, do not go below previous IV sites
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5
Q

What is phlebitis ?

A

inflammation of the lining of the vein
- red, painful, streak up vein, possible cord formation (hardening of vein)

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6
Q

What is the difference with infiltration or extravasation ?

A
  • infiltration: leakage of a med that doesn’t irritate the skin
  • extravasation: leakage of a med that irritates the skin
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6
Q

What are symptoms of infiltration or extravasation ?

A

cool, pallor to skin, could be painful, swollen

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7
Q

If infiltration is severe, what can you do to resolve it ?

A

apply a compress and elevate the affected limb
- aspirate fluid before removing catheter
- warm or cold compress depends on the facility

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8
Q

What is air embolism ?

A

obstruction caused by air entering the vein

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9
Q

What are symptoms of air embolism ?

A
  • difficulty breathing
  • wheezing
  • cough
  • decreased BP
  • increased HR
  • chest pain
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10
Q

What can air embolism lead to ?

A

shock, brain injury, MI, and death

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11
Q

What can do you to prevent air embolism ?

A
  • prime all tubing carefully, check tubing, and IV sets for bubbles
  • change bags before they run dry
  • stop infusion, position pt with head down on their left side
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12
Q

How do you prevent infections at IV sites ?

A
  • limit disconnecting tube
  • teach pt to not handle IV site
  • watch pt with SAGE/CHG bath daily
  • use catheter stabilization device or tape IV site securely
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13
Q

What is the purpose of whole blood administrations ?

A

replacement in severe traumatic injuries

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14
Q

What is the purpose of packed RBC blood product ?

A
  • sickle cell disease
  • cancer
  • anemia
  • surgery
  • blood loss
  • trauma
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15
Q

What is the purpose of granulocyte blood products ?

A

neutropenia

16
Q

What is the purpose of platelet blood products ?

A

decreased platelets from cancer

17
Q

What is the purpose of plasma blood products ?

A

bleeding disorders, burns, shock
- in need of clotting factors

18
Q

When administering blood what do you do ?

A
  • determine if pt knows reason for blood transfusion
  • do they have a recent type and screen in the EHR
  • take baseline VS
19
Q

What do you ask to see if pt knows the reason for blood transfusions ?

A
  • have they had a previous blood transfusion
  • have they had a previous blood transfusion reaction
  • is the blood transfusion consent signed
20
Q

How many RNs must verify blood transfusions ?

A

2

21
Q

When administering blood, what can you hang with it ?

A

normal saline
- 0.9% NS only

22
Q

What are signs of Anaphylactic shock with blood transfusions ?

A
  • anxiety
  • itching
  • wheezing
  • cyanosis
  • shock
  • rapid onset
23
Q

What do you do for a pt with an anaphylactic shock with blood transfusions ?

A

stop treatment immediately and will likely need to give Epi

24
Q

What causes a acute hemolytic reaction ?

A

incompatibility to antibodies causing RBC breakdown

25
Q

What is febrile non-hemolytic ?

A

sensitization to specific blood components
- caused by antibodies against donor WBCs

26
Q

What are some signs of febrile non-hemolytic ?

A
  • chills
  • fever
  • HA
  • flushing
27
Q

What causes a mild allergic reaction to transfusion ?

A

sensitivity to plasma proteins
- S & S: flushing, itching, hives

28
Q

What type of needle gauge is used for blood admins ?

A

prefer IV to be 20 gauge or larger

29
Q

How long do you stay with the pt’s after and before blood admin ?

A
  • stay with pt for 1st 15 min and monitor for side effects
  • take VS after first 15 mins and end of transfusion
30
Q

How long do we transfuse blood over ?

A

up to 4 hrs
- beyond 4 hrs there is a risk for bacterial contamination

31
Q

For the first 15 mins of blood infusion, how long should you take ?

A

infuse blood slowly

32
Q

What are some S & S of acute hemolytic reaction ?

A
  • chills
  • fever
  • low back pain
  • flushing
  • tachycardia/pnea
  • hypotension
  • hemoglobinuria
  • sudden oliguria (AKI)
  • cardiac arrest
  • death
33
Q

What are some RN actions for transfusion reactions ?

A
  • stop transfusion immediately (disconnect blood and saline tubing from IV- leave only the saline lock)
  • keep IV line open with new saline and IV tubing
  • maintain airway
  • notify HCP
  • remain with pt, observe S & S monitoring VS as often as every 5 mins
  • save blood container and tubing