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NRSG 202 > Week 7: IV Push Medications and PICC Lines > Flashcards

Week 7: IV Push Medications and PICC Lines Flashcards

1
Q

All IV meds

A

Considered HAM

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2
Q

Additional Pareneteral medication rights

A

Right Dilution
Right Compatibility
Right rate of administration

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3
Q

Additional rights for an infusion pump

A

Right infusion device
right protocol
right program settings

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4
Q

What is a PICC

A

A central line inserted into a peripheral vein

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5
Q

Where is a PICC usually inserted

A

into cephalic, basilic or median cubital vein above the antecubital fossa

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6
Q

Where does the PICC tip rest

A

lower portion of the distal superior vena cava

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7
Q

How is a PICC inserted

A

usuing a ultrasound machine at the bedside, usually 30-45 minutes

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8
Q

After a PICC is inserted

A

location needs to be verified with a chest X ray

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9
Q

what duration is usually when a PICC is used

A

for treatments expected to last more than 1 months but less than a year

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10
Q

What should never occur on an arm with a PICC

A

Blood pressure should not be taken

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11
Q

Catheters positioned within the heart

A

have an increase risk of mortality

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12
Q

Catheteres positioned perpendicular to the vein wall

A

have an increased risk of vessel erosion, hydrothorax, hydromediatinum, tamponade, and extraversion

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13
Q

Nurses should never use a CVAD…

A

until the tip position is confirmed

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14
Q

Valved PICC

A

allows infusion and aspiration through the VAD but prevents back flow when not in use

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15
Q

Non Valved PICC

A

has a clamp to prevents reflux or back flow

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16
Q

What do non valved PICCs require

A

a heparin lock to keep patent

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17
Q

What is a PICC Power Injectable

A

a purple central venous catheter that allows power injection of contrast media for scans

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18
Q

what is a power injectables gauge and max rate

A

Max rate: 5mL/sec
Gauge: 18

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19
Q

what do power injectables often require

A

heparin flush

20
Q

Advantages of multi-lumen CVADs

A

may administer multiple medications at the same time
may administer multiple incompatible medications at the same time

21
Q

PICC Indications

A

IV fluids/blood products
medications
vesicants
irritants
solutions with extreme pH values
hypertonic solutions
obtain venous blood samples

22
Q

Role of nurse with CVAD care

A
  1. ensure asepsis
  2. assess site
  3. ensure patency
  4. assess PICC dressing
  5. Check external length
  6. assess for CVAD complications
23
Q

Perfoming flush check steps

A

1.check for resistance on aspiration, ability to withdraw blood and ability to infuse fluids without resistance
2. 3-5mL push pause
3. med
4. 10mL after (lock with saline/heparin)

24
Q

How often is a patency check done?

A

once every shift

25
Q

How often is transparent gauze changed?

A

Q7 days and PRN

26
Q

How often is a securement device changed

A

Q7 days and PRN

27
Q

How often is a needless cap changed

A

Q7 days and PRN

28
Q

what is used to clean a PICC site

A

chlorhexidine

29
Q

How often does the external length of the catheter need to be measured?

A

every dressing change and PRN

30
Q

when does the measurement of a catheter need to be reported?

A

if over 2cm difference from initial measurement

31
Q

What are potential CVAD complications

A

infection
occlusions
phlebitis
catheter migration
pulmonary embolism
air embolism
catheter embolism
pneumothorax/hemothorax
arrhythmia

32
Q

Some complications rare in peripheral lines but common in central like:

A

Air embolus
catheter embolus
pneumothorax/hemothorax
arrhythmias

33
Q

Air embolism

A

when air bubble lodges in the body

34
Q

interventions for an air embolism

A

place client on left side in trendelenburg position

35
Q

If an air bubble travels to brain, heart or lungs

A

can cause an MI, CVA, or resp failure

36
Q

Pneumothorax/hemothorax

A

caused by accidental puncture of the pleura or lung during insertion

37
Q

Arrhythmia

A

when CVAD is advanced into the right atrium and it irritates the heart

gives irregular beats you hear on auscultation

38
Q

How long should IV medication bags be hung

A

24 hours max

39
Q

What syringe is used to flush peripheral IV

A

3-12 mL

40
Q

What syringe is used to flush PICC/CVAD

A

10mL or greater

41
Q

What do abx meds need prior to administration?

A

Be warmed after coming out of fridge

42
Q

IV push through PVAD Steps

A
  1. Take MAR and med to bedside + patient identify
  2. Assess IV site, tubing,pump
  3. Determine med math
  4. Stop pip and close roller clamp
  5. swab lowest port and attach saline
  6. assess for patency and flush 3-5mL
  7. swab port and attach med
  8. swab port and flush with 10mL
  9. open roller clamp and restart pump
43
Q

if a med is not listed under compatibility with another med what do you assume

A

assume it is incompatible (its probably never been tested together before)

44
Q

Steps to give IV push with incompatible solution

A
  1. Take MAR and med and perform check
  2. Assess site, tubing, bag, pump
  3. med math
  4. stop pump and close roller clamp
  5. swab lowest port and attach NS
  6. pinch line above port
  7. aspirate and flush with 10mL
  8. give med
  9. flush with another 10 while line is pinched
  10. release pinch, remove syringe, start pump again
45
Q

Drawing up morphine with diluent in syringe method

A
  1. swab NS vial
  2. inject air and draw up 9mL NS
  3. draw up 1mL of morphine
  4. waste morphine
  5. have RN IDC
  6. label with med name, dose, volume, route, rate, and patient
46
Q

Catheter occlusion causes

A

clamped or kinked
tip against wall of vessel
thrombosis
precipitate build in lumen

47
Q

Signs and symptoms of catheter occlusion

A

sluggish infusion or aspiration
unable to infuse or aspirate

NRSG 202 (8 decks)

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