Nursing Management of Central Venous Catheter – Flashcards
Unlock all answers in this set
Unlock answersquestion
central venous catheter
answer
a central venous access device used for administration of sterile fluids, nutrition formulas, and medications into central veins, whose tip lies within the lower third of the vena cava (superior or inferior) or right atrium
question
other names for a central venous catheter
answer
central line (CL), central venous access device (CVAD)
question
3 primary causes of nosocomial disease?
answer
1. central line 2. Foley catheter 3. C-Diff
question
superior vena cava syndrome
answer
blocked SVC, no longer usable
question
Types of central catheters: (4)
answer
Peripherally Inserted Central Catheters (PICC) Non-tunneled Central Catheters Skin-tunneled Central Catheter Implanted Port
question
PICC
answer
- peripherally inserted central catheter - single or double lumen - sterile insertion procedure in antecubital or upper arm vein - insertion at bedside or radiology - no BP or blood draws in PICC arm - will have dressing on for 7 days, unless excess bleeding, then 24 hrs.
question
Non-tunneled CVC
answer
- two-five lumens - subclavian or IJ - may include central venous pressure monitoring - bedside sterile insertion procedure - sutured in place
question
Which site for a non-tunneled CVC is easier/harder? Why?
answer
- Subclavian is easier to manage. Can clip chest hair and get dressing to stick. - IJ is harder to manage, especially at hairline. Men's facial hair grows quickly, causing bandage not to stick. If person is up and moving, bandage will not stick. Can lead to infections.
question
Tunneled CVC
answer
- single, double, or triple lumen - cuff (made to hold line in and serve as a barrier) - surgical insertion in or radiology - two incisions (must be kept sterile) - no dressing at site once tunnel heals - can't bathe, swim, hottub - need loose fitting clothes to cover - need to determine which line is best for each individual pt.
question
Implanted Ports
answer
- single or double lumen - surgical insertion in or radiology - titanium or plastic port - Huber needle access required (wont core a porticath) - done same as tunnel CVC, except incision is closer & port is tucked inside - In past, HIV pop prefered d/t body image
question
steps for accessing a port: (5)
answer
- don sterile gloves & mask (mask pt) - prep site aseptically per protocol - allow site to dry - insert non-coring Huber needle (straight down) - withdraw 3 cc waste (get rid of heparin, draw blood) - flush with 10mL NS
question
What do you inject when de-accessing a line? Long-term & short-term?
answer
- Long - inject 100 cc of heparin (anticoagulant) - Short - 10 cc
question
Reasons for CVC insertion: (7)
answer
- long-term access - emergency access - central venous pressure monitoring - poor peripheral access - frequent blood samples - caustic or hypertonic infusions - patient's choice
question
Nursing care r/t CVC bedside insertion: (9)+
answer
- assess pts ability to tolerate procedure - consent for procedure - adequate anelgesia - code cart available - x-ray confirmation prior to use - frequent assessment for post-insertion complications - assist with bedside insertion + - document procedure - label dressing & tubing
question
Inserting a CVC at the bedside is a 2 person job. How can you assist? (7)
answer
- insertion kit/supplies - lighting - position pt (head down if tolerable) - assist w/ priming catheter - assess catheter for defects - maintain sterile technique - monitor patient continuously
question
Nursing maintenance of CVC's: (7)
answer
- daily flushes, per protocol - medication, blood and fluid administration - draw blood samples for lab orders (nurse only if directly out of line, not lab tech) - line occlusion procedures - site assessment (look for infection: REEDESS) - dressing and cap changes per protocol - discontinue non-tunneled/non-implanted lines
question
Frequency of CVC dressing change based on type of dressing:
answer
- transparent dressing - every 7 days - gauze & tape or Tefla island dressing - every 48 hours - PRN dressing dislodged, torn, soiled
question
Why might you use gauze or Tefla over a transparent dressing?
answer
- skin breakdown - oozing at insertion or suture site
question
Why might you have to change a transparent dressing more often than every 7 days?
answer
- pt sweating a lot & clean gloves - hair growth moving bandage
question
Steps for CVC dressing change: (19)
answer
- as per facility protocol - gather supplies - wash hands - mask on patient per protocol - don mask & clean gloves - remove old dressing (careful not to dislodge line) - remove gloves - rewash hands (per SPH policy) - don sterile gloves - clean site for 30 seconds - chlorhexadine swab - start at line entry site and work outward - don't forget suture sites if applicable - allow to dry completely - apply Biopatch - apply sterile dressing - label dressing - date of dressing change & insertion, initials - SECURE TUBING
question
How often and why do you change CVC positive end pressure end-caps (hubs)?
answer
- change injection caps per facility protocol - transparent dressing changes - weekly - tubing changes - Q72-96 hours - after blood draws - PRN
question
steps for CVC blood draws: (5)
answer
- flush with 10-20 ml NS - withdraw and discard 5 ml blood - draw blood sample - flush with 20 ml NS - NO VACUTAINERS (pressurized tubes)
question
List CVC hazards: (17)
answer
- infection --> sepsis - phlebitis - thrombosis - insertion related: - painful/traumatic - general anesthesia (tunneled & implanted port) - pneumothorax/hemothorax - hemorrhage - nerve damage - infiltration or extravasation - catheter occlusion - catheter malposition - tip migration and dislodgement - pulmonary, air, and catheter emboli - long-term maintenance requirements - body image (port) - activity limitations
question
CVC assessment & documentation: (10)
answer
- S & S of infection - local & systemic - pain/tenderness/swelling along line tract - external bleeding or hematoma - patency - swelling of affected limb/neck/face - sensation/pain to affected limb - breath sounds - respiratory rate/effort - xray
question
What should you do if a non-tunneled CVC gets infected?
answer
- need to care for to avoid sepsis - high priority - remove - clean - culture tip & site, send to lab
question
What should you do if an implanted port gets infected?
answer
- ensure port access is still good - attempt to draw blood - inject 100 cc's of saline & look for swelling - do not proceed with meds w/o knowing port is viable internally
question
nursing assessment: occlusion (8)
answer
- inspect catheter for external kinks - port-a-cath Huber Needle placement - reposition patient (pinch off syndrome) - review medications and parenteral nutrition - instill thrombolytic - suggest ultrasound or radiology - diagnose & treat PRN - anticoagulant therapy
question
what is the purpose of using a Biopatch?
answer
it prevents infection at CVC line sites
question
CRBSI
answer
catheter related blood stream infection
question
CHG
answer
chlorhexidine gluconate
question
How many times its weight in liquid can the biopatch absorb?
answer
8 times
question
how often does a biopatch need to be changed?
answer
every 7 days
question
How does a biopatch function?
answer
it suppresses patients own microflora
question
what happens when a biopatch is full of blood?
answer
it still delivers CHG continuously, despite the blood
question
4 P's for applying a statlock:
answer
Prep Press Peel Place
question
2 D's for removing a statlock:
answer
remove bandage press catheter in place Disengage Dissolve
question
pistoning
answer
catheter motion
question
How can you avoid catheter pistoning?
answer
use extra line to create a C or s curve to limit movement
