question

What is CVAD?

answer

They are catheters placed into large veins, usually the subclavian vein or jugular vein to deliver IV therapy Tip is located in the superior vena cava above right atrium Access sites: -internal jugular -subclavian : more secure -cephalic -brachial -basilic -femoral vein SVC - empties into right atrium of heart Other types of lines considered central line (Swan ganz, hemocath

question

where is tip of CVAD located?

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Tip is located in the superior vena cava above right atrium

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Access sites of CVAD?

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Access sites: -internal jugular -subclavian : more secure -cephalic -brachial -basilic -femoral vein

question

Purpose of CVAD?

answer

Administration of: -IV fluids -blood and blood products -TPN -meds -traumua pts need fluids fast -vasoactive drugs -chemotherapy: +obtain blood samples +long term IV therapy- hospital, ECF, or home

question

chemotherapy and CVAD

answer

-chemotherapy: +obtain blood samples +long term IV therapy- hospital, ECF, or home

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Advantages of CVAD

answer

-access to central circulation system -provide access for IV meds, vasoactive vesicants -decrease need for frequent venipuncture -decrease extravasation and phlbetitis -patients with limited peripheral veins -long term IV therapy

question

disadvantages of CVAD

answer

-invasive line -procedure to insert -systemic infection -sepsis -complications air or thrombus embolism, pneumothorax

question

4 Types of CVAD

answer

1. Nontunneled: Central venous Catheters (CVC) Ex. Triple Lumen 2. Tunneled Catheters: Ex. Hickman, Broviac 3. Peripherally Inserted: Central Catheters PICCs 4. Implanted Port: Port-A-Cath

question

Nontunneled Central Venous Catheter site? where inserted? conformation? securement? time frame?

answer

Site: subclavian, jugular or femoral vein Inserted at bedside Placement confirmed with X-ray Held in place with sutures or securement device Short term therapy

question

Nontunneled CVC lumens? flush? risk?

answer

1 to 4 lumens Flush with normal saline May flush with low concentration heparin (100 units/ml) Femoral access possible but not first choice, - increase risk of infection Risk: pneumothorax

question

Tunneled Central Venous Catheter site? insertion? securement? time frame?

answer

Site: chest, subclavian Inserted in OR or IR Held in place Dacron cuff Long term use tunneled subcutaneously to exit site on chest

question

Tunneled Catheter types? how works?

answer

Examples: Groshong, Hickman Has a valve that reduces risk of blood reflux and clotting >> no need for Heparin Pressure opens and closes valve

question

Peripherally Inserted Central Catheter

answer

length 20-24 inches No venipunctures or blood pressures in arm Assess for catheter migration by measuring external catheter length from hub to insertion site Held in place with sutures or securement device Power PICC: larger lumen, withstand more pressure *NEVER use a syringe smaller than 10mL * A mid-line catheter is shorter (8-10 inches), not the same Midline tip under axillary area, longer than a peripheral but shorter than CVC, not central venous access Caution: Looks same as PICC but not caution when infusing meds or TPN

question

PICC - Double Lumen

answer

Note clamps and stabilization, 10 ml syringe

question

Implanted Subcutaneous Port site and type

answer

Long term use (oncology patients) Sites: chest, abdomen, inner arm "hidden" under the skin, when not accessed nothing external No dressing change once healed, Tunneled catheter Single or double port Access with a 90 degree non-coring safety needle

question

Port-A-Cath

answer

Surgically implanted port subcutaneously, accessed with Huber needle; flushed with heparin Usually Needle changed every 7 days

question

Needle free cap/hub connector

answer

All CVC need an adapter or "cap" to provide a closed system to prevent air from going in and blood flowing out.

question

Nursing Management of CVADS what needs to be done before using it?

answer

Assist MD/HCP with insertion Confirm placement before using catheter!!!!!! Assessment and maintenance is RN responsibility Maintain patency Maintain sterile technique Apply dressing and cap changes per protocol Administer IV fluids & medications Prevent complications - *infection* * Always per hospital protocol*

question

assessment of catheters

answer

Type of catheter Date inserted, date of last dressing and cap change Skin integrity insertion site & surrounding area- redness, edema, pain, drainage, leaking Assess patency of catheter Assess for signs or complications Assess patient's knowledge ; learning needs

question

Flushing the catheter reason and technique

answer

To maintain patency Wash hands apply non-sterile gloves Flush with 10mls of sterile normal saline (20 mls following blood draw) Use 10 ml pre-filled saline syringe expel all air bubbles Scrub hub - twist alcohol wipe for 15 -30 seconds ; allow to dry Push-Pause technique Flush ALL lumens not being used for infusions Clamp unused ports if indicated per protocol Syringe size - smaller creates increased PSI, "Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol)" CDC Guidelines

question

Which lumens get flushed on catheters

answer

Flush ALL lumens not being used for infusions Clamp unused ports if indicated per protocol

question

Push pause technique and why?how to end?

answer

Creates positive pressure ; turbulence to keep catheter patent Push 1 -2 mls, pause, push 1-2 mls pause, continue until all 10 ml instilled but END with positive pressure Alternate pushing ; pausing on syringe plunger apply a steady gentle pressure

question

Flushing catheter procedure?

answer

Don non-sterile gloves "scrub hub" with alcohol or chloraprep Allow to dry Expel air bubbles from 10 mL pre-filled saline syringe Attach saline flush to catheter hub, twist on Inject saline using push-pause technique (positive pressure) End with pressure on plunger while removing syringe Apply disinfectant cap IF Heparin flush indicated per protocol: Scrub hub again for 15 seconds Attach heparin filled syringe (100u or 10u per mL) Instill correct amount of Heparin per hospital protocol Apply disinfectant cap

question

Administering Medication S.A.S.H Method

answer

"Scrub hub" - antiseptic solution (15 - 20 seconds) each ; every time you access S aline - sterile normal saline 10 ml syringe A dminister - IV medication - using 6 rights ; 3 checks! S aline - flush with 10 ml saline after IV medication H eparin - only if indicated **per protocol** **heparin may be used as last flush to prevent thrombus forming, low concentration 100u/mL or 10u/mL

question

why do we use a 10 mL syringe with flushing a catheter?

answer

Use a 10 ml syringe because smaller size syringes create increased pressure on catheter lumen

question

Administering a med via CVAD part 1

answer

Perform the 3 checks ; 5 rights of medication gloves Scrub hub ; allow to dry Attach prefilled 10 mL saline syringe *Pull back plunger slightly to aspirate small amount blood Inject saline using push-pause and remove syringe

question

administering a med via CVAD part 2

answer

Scrub hub again Connect IV tubing with medication ; set IV pump to infuse at correct rate (ml/hr) When infusion complete - Disconnect IV tubing, put a sterile cap on end of IV tubing scrub hub and flush (push-pause) with 10 mLs of saline If using Heparin ; scrub hub again and administer Heparin as prescribed per hospital protocol Apply disinfectant cap Clamp CVC if indicated

question

CVAD dressing change

answer

Gauze dressing for first 24 hours then..... Transparent dressing Wash site with antiseptic solution (chlorhexidine) for 30 seconds Chloraprep applicator - break ampule release antiseptic into sponge allow time to air dry Apply stabilization device label dressing Usually every 7 days ; PRN Measure catheter length

question

Central Line Dressing Kit

answer

it is a sterile container mask, gloves, chloraprep, transparent dressing, tape, gauze, label

question

how to secure CVAD

answer

with stabilization device

question

Dressinf change procedure

answer

1. Wash hands 2. Open sterile dressing kit 3. Don mask ; nonsterile gloves 4. Remove old dressing with clean gloves 5. Inspect insertion site (redness, drainage, edema) 6. Don Sterile gloves 7. Wash site - with chlorhexidine for 30 seconds using repeated back ; forth strokes, entire area under dressing, gentle back ; forth friction 8. Allow to air dry 9. Apply sterile transparent dressing (no wrinkles) 10. Position so insertion site is in center of dressing 11. If CHG gel pad dressing center it over insertion site 12. Apply securement tape or device if indicated 13. Label dressing - date, time ; initials 14. Wash hands 15. Document

question

cap change for CVAD

answer

Change Caps per agency protocol Prime cap with sterile normal saline Clamp catheter Using aseptic technique twist off old cap Scrub the end (threads) of catheter 15 to 30 seconds with alcohol Attach new cap twist completely Unclamp ; Flush catheter Apply disinfectant cap

question

nursing interventions for CVAD? can it be delegated?

answer

Draw blood samples - discard 3-5 mLs first, draw blood samples then flush with 20 mL NS Measure length of catheter (PICC ; Hickman) Measure circumference of arm (PICC) Apply securement device Assess insertion site for signs of infection *Document- assessment, dressing ; cap change Patient teaching for home care Care of CVAD can not be delegated

question

revmoval of CVAD

answer

*** According to agency policy *** RNs that have demonstrated competency Remove dressing, sutures, stabilization device Ask patient to perform the Valsalva maneuver, take deep breath ; hold it. Valsalva maneuver to prevent air embolism Remove catheter with smooth continuous motion Inspect tip of catheter; ? send tip for culture Apply pressure to insertion site Apply dressing- petroleum-based occlusive dressing antibiotic ointment Measure tip of catheter, PICC

question

what type of dressing is applied after CVAD removal?

answer

Apply dressing- petroleum-based occlusive dressing antibiotic ointment

question

CVAD: what assessments will be found and the interventions for CVAD occlusion or formation of clot?

answer

Assessment: Can not flush. No blood return check for mechanical obstruction 1st intervention: Flush using proper technique Heparinize if indicated Administer thrombolytics per protocol only

question

CVAD: what assessments will be found and the interventions for CVAD Blood infection CR-BSI (CLABSI) Local or systemic

answer

assessment: Fever, Shaking, chills, Positive blood cultures interventions: Strict asepsis Clean skin with antiseptic Cap changes Scrub hub Culture ; Antibiotics

question

CVAD: what assessments will be found and the interventions for CVAD Pneumothorax complication

answer

assessment: Absent breath sounds Chest pain respiratory distress interventions: CXR Oxygen Chest Tube

question

CVAD: what assessments will be found and the interventions for CVAD Embolism air or thrombus complication

answer

assessment: Chest pain respiratory distress interventions: Clamp, Valsalva Oxygen Pt. on left side

question

CVAD: what assessments will be found and the interventions for CVAD Malposition or Dislodgement

answer

assessment: No blood return Edema at site Occlusion interventions: Confirm placement Aspirate for blood return Use securing device Assess length

question

other possible CVAD complications

answer

Other complications: skin erosion, catheter damage or breakage, infiltration, extravasation, incorrect placement

question

Preventing CLABSI (CVAD)

answer

Institute for Healthcare Improvement The Central line bundle is a set of 5 interventions 1. Hand hygiene 2. Maximal barrier on insertion 3. Chlorhexidine skin antisepsis 4. Site selection 5. Daily review for need with prompt removal of unnecessary lines Use of disinfectant caps

question

catheter occlusion

answer

Intraluminal thrombus Inability to flush or aspirate blood from catheter Never force flush when meeting resistance Follow protocol for declotting catheter Use a "clot buster" ex., Alteplase * Per agency protocol only* NEVER flush a CVAD, administer medication or perform dressing or cap change without your Clinical instructor present

question

key points to remember with CVAD

answer

Fluid ; Electrolytes Skin Integrity Infection

Nursing Care of Central Venous Access Devices Nursing 201 Exam 1 – Flashcards

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