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243 > Weeks 1-3 > Flashcards

Weeks 1-3 Flashcards

1
Q

List 7 benefits of a CVAD

A

Long term IV therapy, administration of vesicants, irritant, blood products, large volumes of fluid, hypertonic solutions, and taking blood samples.

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2
Q

Where is the final tip location of the CVAD catheter?

A

Cavo-atrial junction (CAJ)

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3
Q

How long can a PICC be left in place? Where is it inserted?

A

4 months. Basilic or cephalic vein.

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4
Q

How is a short term vs a long term CVAD held in place?

A

Short term: with securement device or sutures. Long term: Dacron cuff coated with antimicrobial solution.

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5
Q

Which type of CVAD(s) are considered permanent? Where must these be inserted (bedside/OR?)

A

Tunneled and implanted venous ports. Done in the OR.

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6
Q

What must be ordered to ensure correct placement of the CVAD? What is a cardiac complication of improper CVAD placement?

A

CXR. Artial fibrillation.

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7
Q

List 3 types of permanent CVADS

A

Hickman, Broviac, and Groshong

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8
Q

How long are short-term CVADs left in place? Where can these be inserted?

A

Days-weeks. At bedside.

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9
Q

How often does a peripheral IV site need to be changed? How often does intermittent tubing need to be changed? Continuous tubing? How often is the dressing site changed?

A

Every 96 hours. Intermittent: q24 hr. Continuous: q96 hr. Dressing changed whenever site is changed or sooner if necessary.

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10
Q

What is an important position to have the patient in before insertion of the short-term CVAD? What risk does having the patient in this position reduce?

A

Trendelenberg. To dilate vein to decrease risk of air embolism.

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11
Q

What are important assessments to complete prior to CVAD insertion?

A

Baseline vitals, patient teaching, respiratory assessment including breathing patterns, depth, symmetry and sounds.

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12
Q

What is included in the assessment of a CVAD site and dressing?

A

Measure the line from site of insertion to hub. Check security of caps and clamps. Assess the site for any abnormal findings and dressing for intactness, assess the tubing for leaks.

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13
Q

What is one thing that is ALWAYS done before touching a cap on a CVAD, PICC or peripheral IV?

A

Cleanse for 30 seconds using friction scrub technique with alcohol swab.

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14
Q

How do you flush a CVAD that is being used for medication administration? What is an important flushing technique that must be used?

A

Need to aspirate before flushing, then flush with 10mL of NS x2 using turbulent-flushing technique (TFT). Administer medication. Flush 10mL NS (TFT), flush with 3mL heparin solution (finish with + pressure).

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15
Q

How do you flush a CVAD lumen that is clamped and not in use?

A

Aspirate for blood return before flushing, flush 10mL NS, followed by another, then the 3mL heparin solution (finish with + pressure).

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16
Q

What is a rule to remember about the lumens in regards to flushing, even if you are only accessing one lumen?

A

Flush one, flush all.

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17
Q

How do you flush an intermittently used valved PICC?

A

Flush 1-2 NS, aspirate for blood return, flush 10 mL (TFT), attach and administer medication, flush 10-20 mL (TFT, leave small amount of NS in syringe)

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18
Q

How do you flush an intermittently used non-valved PICC?

A

Aspirate for blood return, flush 10mL NS, attach and administer med, administer 10 mL NS, administer heparin solution (save last 0.1-1mL for + pressure).

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19
Q

How do you flush a capped valved PICC?

A

Flush 1-2 mL NS, aspirate blood, administer 10-20mL NS, apply + pressure with last 1 mL.

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20
Q

How do you flush a capped non-valved PICC?

A

Aspirate blood, flush 10-20mL (TFT and + pressure), heparin solution (+ pressure).

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21
Q

What is the most life threatening complication of a CVAD?

A

Air embolus

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22
Q

List 5 CVAD complications?

A

Infection, thrombus, catheter migration, infiltration/extravasation, air emboli.

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23
Q

How do you change CVAD caps?

A

Prep new injection cap, remove cap from package and clean with alcohol swab, keep protective end of injection cap, prime cap by attaching NS and flush until fluid is seen.

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24
Q

What are three causes for an IV not running?

A

Clot, cannula pressed up against vein, and dressing is too tight.

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25
Q

A short-term, non-tunneled CVAD has the highest risk for what?

A

Infection

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26
Q

Which types of IV’s need CXR placement confirmation?

A

PICC, tunneled and non-tunneled CVAD.

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27
Q

Peripheral IV flush: how often? What technique? How much fluid?

A

q8-12 hr, turbulent flow, 1-3 mL.

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28
Q

Peripheral IV dressing change… how often? Transparent? Gauze?

A

q96. q72 and PRN.

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29
Q

A PICC line should not move more than ___ cm in an adult patient.

A

5cm.

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30
Q

A PICC line should not move more than ___ cm in a pediatric patient?

A

1 cm.

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31
Q

What is a “groshong” valve?

A

A special one-way valve on some PICCS. Negates heparinization of PICC line.

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32
Q

Which CVAD should you be cautious with when doing venipuncture or measuring BP?

A

PICC

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33
Q

What is the purpose for having multi-lumen catheters on PICCs and CVADs?

A

Administration of incompatible drugs simultaneously.

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34
Q

What are 8 manifestations of air embolus?

A

Increased HR (thready), low BP, anxiety, decreased LOC, dyspnea, chest pain, dizziness, and cyanosis.

35
Q

What are the steps you should take if you suspect your patient has a air embolus?

A
  1. Clamp IV. 2. Place client in LEFT trendelenberg. 3. Call for help. 4. Administer O2. 5. VS and breath sounds.
36
Q

What syringe must be used for all CVADs and why?

A

10mL syringe as anything smaller will damage the tubing of the CVAD due to the pressure the fluid will exert when pushed out.

37
Q

What are three examples of crystalloids?

A

NS, D5W, and Ringers Lactate.

38
Q

What are isotonic fluids?

A

Same osmolarity of blood, no fluid shift occurs. Ex. NaC, Lactated Ringers.

39
Q

What are hypertonic fluids?

A

Higher osmolarity than blood, fluid moves out of cells and into intravascular space. Ex. D50W, 5% NaCl.

40
Q

What are hypotonic fluids?

A

Lower osmolarity than blood, fluid shifts into the cells (hydrate cells). Ex 0.45% NaCl, 0.33% NaCl

41
Q

How many ggts/min in a micro drip? Macro drip?

A 
Micro= 60. 
Macro= 10, 15.
42
Q

What does “KVO” mean? And when will you see this happen on an IV pump?

A

Keep Vein Open. This mode will kick in when IV bag is near empty.

43
Q

What do you do if your patient complains of tenderness at the IV site?

A

Assess site for erythema, swelling, infiltration. If manifestations indicate infiltration or phlebitis discontinue IV and treat site with warm compress (moist and warm for phlebitis). Elevate limb if infiltration.

44
Q

What are manifestations of extravasation?

A

Erythema, inflammation, pain, blistering, necrotic tissue.

45
Q

What do you do if your patient experiences extravasation?

A

Stop infusion, cool compress then warm, notify physician.

46
Q

What are manifestations of infiltration?

A

Edema at site, pain, coolness, significant decrease in flow rate, leakage of IV fluid at site.

47
Q

What do you do if your patient experiences infiltration?

A

Discontinue IV and restart in other limb or proximal to infiltration, use a warm compress if it was a small volume of non-caustic solution. Raise extremity.

48
Q

What are manifestations of phlebitis?

A

Palpable venous cord, erythema, pain, swelling.

49
Q

What do you do if your patient has phlebitis?

A

Discontinue IV, warm and moist compress.

50
Q

What does the Valsalva maneuver accomplish when changing a CVAD cap?

A

To increase central pressure to reduce risk of air embolism when changing caps.

51
Q

If blood gets into injection cap what must be done?

A

Change injection cap.

52
Q

What are some ways you can prevent an occlusion of a CVAD (4)?

A

Routine flushing, positive pressure/turbulent flushing, flush between meds, and don’t kink tubing.

53
Q

What are some ways you can prevent infection from a CVAD (4)

A

Aseptic technique, prevent contamination of catheter hub, proper dressing technique, and transparent semipermeable dressing.

54
Q

What are some ways to prevent an air embolus (3)?

A

Put injection cap on distal end when not in use, don’t leave catheter open to air, clamps.

55
Q

When would you use positive pressure to finish off flushing an IV? With which types of IVs?

A

CVC, peripheral IVs and non-valved PICCs

56
Q

Which type of IV doesn’t require positive pressure, but you cannot bottom out syringe?

A

Valved PICC

57
Q

Do you always need gloves when flushing PICCs and CVCs?

A

Yes.

58
Q

With what route of medication administration (which type of IV) must you administer the second flush post-med at the same rate as you delivered the medication?

A

Peripheral IV

59
Q

How often are PICC dressings and caps changed? Transparent? Gauze?

A

Transparent - q 7 days

Gauze - q 48 hr

60
Q

What is speed shock?

A

When you give an IV medication way too quickly.

61
Q

What medications are given through the distal lumen of the CVC?

A

TPN, blood and blood products, central venous pressure monitoring.

62
Q

What can be given through proximal lumens on CVCs?

A

General lumen, medications, fluids etc.

63
Q

What can be given through the medical lumens on CVCs?

A

General lumen, medications, blood and blood products.

64
Q

Can you give incompatible meds to someone with a PICC?

A

Yes, must be through different lumens.

65
Q

If you need to give two meds, only have one lumen, and the meds aren’t compatible what do you do?

A

Flush, med, flush, med, heparin solution.

66
Q

If you must add a mediation to a primary bag (continuous bag) and you are to add 10% or more of the volume of the primary bag to the primary bag, what do you do?

A

Withdraw that 10% and then add in the medication.

67
Q

What drug causes Red Man Sydrome?

A

Vancomycin

68
Q

If your patient is receiving chemo drugs PO what PPE should you wear? IM/IV chemo?

A

Gloves. Gloves, water resistant gown, and goggles.

69
Q

Which patients are particularly at higher risk for infiltration/extravasation (5)?

A

Elderly, confused, agitated, fragile skin, PVD.

70
Q

Grades 1-3 infiltration scale includes:

A

Blanched skin, edema, cool to touch, with or without pain.

71
Q

Grade 4+ infiltration scale:

A

Bruising, discoloration, skin tight or leaking, pitting edema, circulatory impairment, severe pain, includes infiltration of blood products irritants or vesicants.

72
Q

What do you do if your patient has extravasation?

A

Stop infusion, disconnect infusion and attach 3mL empty syringe to cannula, gently aspirate, then remove cannula and place gentle pressure with 2x2 over site. Place cold, dry pack for 10 minutes and elevate area. Initiate an IV in new arm.

73
Q

If your patient requires regular IV fluid after receiving IV chemo what do you do?

A

Change the IV tubing.

74
Q

How do you dispose of cytotoxic items?

A

In 2 yellow bags labeled “cytotoxic” with each bag tied.

75
Q

Where must the RN record where he or she gave chemo drugs?

A

Staff record for administration of cytotoxic drugs

76
Q

How long after chemo has been administered to a patient must you wear gloves, goggles, and water repellent when handling bodily fluids etc.

A

48 hours.

77
Q

Where must all chemo bodily fluids be disposed of?

A

Toilet

78
Q

How do you dispose of linen that has been soiled with bodily fluids from a patient on chemo?

A

Need to wrap them up in a clear bag and then put in general laundry bin.

79
Q

How do you flush a CVC post blood draw?

A

20 mL NS and then heparin solution.

80
Q

If your patient is bleeding out of their IV site what do you do?

A

Clamp IV, place patient in trendelenberg (get blood to brain).

81
Q

If you have two medications due at 0900, one needs to be run over 12 hours and the two aren’t compatible what do you do?

A

Piggyback the one that needs to be run over 12 hours, then stop infusion, pinch off tubing, flush with NS to lower port, administer med via IV direct over X amount of time, administer flush at same rate.

82
Q

What is the sandwich method?

A

Piggy back and direct, giving two incompatible meds.

83
Q

What can happen if IV meds are infused too quickly?

A

Speed shock

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