Week 7: IV Push Medications and PICC Lines

Question 1

All IV meds

Answer 1

Considered HAM

Question 2

Additional Pareneteral medication rights

Answer 2

Right Dilution
Right Compatibility
Right rate of administration

Question 3

Additional rights for an infusion pump

Answer 3

Right infusion device
right protocol
right program settings

Question 4

What is a PICC

Answer 4

A central line inserted into a peripheral vein

Question 5

Where is a PICC usually inserted

Answer 5

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

Question 6

Where does the PICC tip rest

Answer 6

lower portion of the distal superior vena cava

Question 7

How is a PICC inserted

Answer 7

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

Question 8

After a PICC is inserted

Answer 8

location needs to be verified with a chest X ray

Question 9

what duration is usually when a PICC is used

Answer 9

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

Question 10

What should never occur on an arm with a PICC

Answer 10

Blood pressure should not be taken

Question 11

Catheters positioned within the heart

Answer 11

have an increase risk of mortality

Question 12

Catheteres positioned perpendicular to the vein wall

Answer 12

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

Question 13

Nurses should never use a CVAD…

Answer 13

until the tip position is confirmed

Question 14

Valved PICC

Answer 14

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

Question 15

Non Valved PICC

Answer 15

has a clamp to prevents reflux or back flow

Question 16

What do non valved PICCs require

Answer 16

a heparin lock to keep patent

Question 17

What is a PICC Power Injectable

Answer 17

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

Question 18

what is a power injectables gauge and max rate

Answer 18

Max rate: 5mL/sec
Gauge: 18

Question 19

what do power injectables often require

Answer 19

heparin flush

Question 20

Advantages of multi-lumen CVADs

Answer 20

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

Question 21

PICC Indications

Answer 21

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

Question 22

Role of nurse with CVAD care

Answer 22

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

Question 23

Perfoming flush check steps

Answer 23

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)

Question 24

How often is a patency check done?

Answer 24

once every shift

Question 25

How often is transparent gauze changed?

Answer 25

Q7 days and PRN

Question 26

How often is a securement device changed

Answer 26

Q7 days and PRN

Question 27

How often is a needless cap changed

Answer 27

Q7 days and PRN

Question 28

what is used to clean a PICC site

Answer 28

chlorhexidine

Question 29

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

Answer 29

every dressing change and PRN

Question 30

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

Answer 30

if over 2cm difference from initial measurement

Question 31

What are potential CVAD complications

Answer 31

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

Question 32

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

Answer 32

Air embolus catheter embolus pneumothorax/hemothorax arrhythmias

Question 33

Air embolism

Answer 33

when air bubble lodges in the body

Question 34

interventions for an air embolism

Answer 34

place client on left side in trendelenburg position

Question 35

If an air bubble travels to brain, heart or lungs

Answer 35

can cause an MI, CVA, or resp failure

Question 36

Pneumothorax/hemothorax

Answer 36

caused by accidental puncture of the pleura or lung during insertion

Question 37

Arrhythmia

Answer 37

when CVAD is advanced into the right atrium and it irritates the heart gives irregular beats you hear on auscultation

Question 38

How long should IV medication bags be hung

Answer 38

24 hours max

Question 39

What syringe is used to flush peripheral IV

Answer 39

3-12 mL

Question 40

What syringe is used to flush PICC/CVAD

Answer 40

10mL or greater

Question 41

What do abx meds need prior to administration?

Answer 41

Be warmed after coming out of fridge

Question 42

IV push through PVAD Steps

Answer 42

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

Question 43

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

Answer 43

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

Question 44

Steps to give IV push with incompatible solution

Answer 44

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

Question 45

Drawing up morphine with diluent in syringe method

Answer 45

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

Question 46

Catheter occlusion causes

Answer 46

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

Question 47

Signs and symptoms of catheter occlusion

Answer 47

sluggish infusion or aspiration unable to infuse or aspirate