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Questions and Answers
What should be done to minimize contamination during medication preparation?
It is acceptable to recap a needle after medication administration.
False
What is a mild reaction to medication?
Localized reaction
The __________ is used to obtain a sterile urine sample.
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Which of the following are contraindications for catheterization?
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What should be done if there are bubbles in the syringe?
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What is the purpose of using a Foley catheter?
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A Robinson catheter can be used for intermittent catheterization.
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What should be done before inserting a catheter?
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The __________ is the term used for a catheter that remains in place and is inflated with a balloon.
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What should be included in a catheterization kit?
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Which of the following solutions is considered an isotonic solution in the bag?
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The primary use of hypertonic solutions is to relieve edema.
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Normal saline has ______ mEq/L of Sodium.
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What is the solution of choice when administering a blood product?
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What condition can result from excessive water loss?
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What is the first step in treating hyperkalemia related to pH levels?
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Match the following terms with their definitions:
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You can safely recap a needle after use.
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A patient is experiencing ________ when there is a loss of 10% body weight.
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What is the max volume for intradermal injections?
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You should draw blood cultures from the same site.
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Which of the following are indications for central line placement? (Select all that apply)
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Subclavian access is associated with a higher risk of infection than jugular access.
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What gauge size indicates a larger needle?
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The maximum duration for using a non-tunneled central line is _____ weeks.
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What is a potential immediate complication of central line placement?
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Match the following catheter types with their characteristics:
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What is a common reason for using a PICC line?
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A catheter fragment embolism is a rare complication that can occur when the catheter tip is sheared off.
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The most common site for central venous access is the _____ vein.
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Which of the following is NOT a contraindication for peripheral IV insertion?
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What is a risk associated with inserting a femoral vein catheter?
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What is one of the main advantages of totally implantable ports?
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Study Notes
Central Lines Indications and Contraindications
- Indications include inadequate peripheral venous access, administration of noxious medications (e.g., chemotherapy, vasopressors), long-term IV therapy, and hemodynamic monitoring.
- Contraindications for central line insertion include anatomical distortion, presence of intravascular hardware, and conditions like hemodialysis catheters.
- Relative contraindications involve AV fistulas, coagulopathy, and thrombocytopenia.
- Gauge refers to needle size, with a higher gauge indicating a smaller needle.
Types of Catheters
- Non-tunneled catheters are commonly used for temporary access and can be single to quadruple lumen.
- Peripherally Inserted Central Catheters (PICCs) are used primarily for outpatient IV therapy lasting 15-30 days, exiting near the vascular insertion site.
- Central venous access is often achieved through jugular veins, favored for accessibility and low complication rates; jugular access is preferred over subclavian due to infection risk.
- Femoral veins are best for emergency access, though they carry risks for hematoma when inserted below the inguinal ligament.
Catheter Insertion and Monitoring
- PICC lines are placed under EKG guidance by specialized teams.
- Tunneling catheters (e.g., Permacath, Hickman) traverse subcutaneous tunnels and are preferred for long-term access, reducing infection rates.
- Implantable ports (e.g., Port-a-Cath) offer long-term access and are accessed through a self-sealing membrane, commonly placed in the upper chest.
Factors Influencing Catheter Selection
- Duration of access: Non-tunneled for short-term, PICCs and tunneled for mid to long-term access.
- Type of infusion: Consider irritant medication and required blood flow region for catheter tip termination.
- Patient considerations: Previous complications or specific health issues.
- Provider expertise plays a role in reducing complications.
Complications of Central Lines
- Immediate complications can include bleeding, arrhythmia, pneumothorax/hemothorax, and air embolism.
- Delayed complications include infection, thrombosis, catheter migration, and embolization.
- Specific risks involve nerve injury and myocardial perforation.
Ultrasonography in Placement
- Utilizes U/S imaging to locate veins and assess patency, providing real-time assistance to reduce complications.
- Important for use in patients with coagulopathy.
Catheter Confirmation and Follow-Up
- Confirmation methods include chest X-ray, fluoroscopy, and endocavitary electrocardiography.
- Regular assessment of IV sites is necessary for signs of infection, infiltration, or obstruction.
Peripheral IV Insertion
- Indicated for fluids, medications, blood products, and nutrition.
- Contraindications include burns, active infections, prior phlebitis, or any conditions impairing circulation.
- Common sites are the dorsal aspect of the hand and forearm; avoid pattern areas like the antecubital fossa in adults.
IV Equipment and Techniques
- Proper equipment includes the right gauge catheter, tourniquet, IV fluids, and antiseptics.
- Insertion techniques involve palpating for vein stability and proper preparation of the site.
- Proper follow-up includes monitoring for infection and maintaining catheter patency.
IV Fluids and Electrolytes
- Total body water: Approximately 60% body weight in males, 50% in females; consists of intracellular and extracellular fluids.
- Colloids serve as volume expanders and remain within the vascular system, whereas crystalloids pass freely through membranes.
- Fluid replacement strategies highlight the difference in maintenance ratios between colloids and crystalloids.
Fluid Management and Estimations
- Fluid loss is assessed with symptoms escalating at 10%, 20%, and 30% extracellular fluid deficits.
- Maintenance IV fluid calculations follow specific weight-related formulas, dividing needs into increments for optimal volume adjustment.
- The 4-2-1 rule provides an easy formula for determining hourly rates based on patient weight.### Electrolytes Review
- Sodium (Na+) is the main cation in extracellular fluid, crucial for circulatory volume.
- Hypernatremia can arise from significant water loss, excessive salt intake, hypertonic IV solutions, and conditions like Cushing syndrome.
- Hyponatremia is commonly caused by diuretics, excessive water intake, or hypotonic fluid replacement.
- Potassium (K+) is the principal intracellular cation and critical for muscle contractility.
- Acidosis causes potassium to shift from cells to plasma, raising serum levels; alkalosis has the opposite effect.
- Hyperkalemia is linked to acute renal failure, diminished aldosterone levels, and metabolic acidosis.
- Hypokalemia can occur due to GI losses, diuretic use, or conditions like primary aldosteronism.
- IV drip types include macro (10-20 drops/ml) and micro (60 drops/ml) for rate control.
Venipuncture
- Indicated for venous blood samples larger than what a fingerstick can provide (e.g., blood type/cross).
- Contraindications include skin infections, areas with AV fistulas, and recent tattoos.
- Complications may include cellulitis, phlebitis, hematoma, and vasovagal syncope.
- Major veins for venipuncture include median cubital (best anchored), cephalic (easily palpated), and basilic (less anchored).
- Vacutainer tubes are designed for efficient blood collection; different colors indicate specific additives for various tests.
- Common colors include lavender (EDTA for CBC), blue (sodium citrate for coagulation), and gold/red (for chemistry).
Injection Techniques
- Goal is to safely administer injections while following standard protocols.
- Different medications are administered via intradermal, subcutaneous (SQ), and intramuscular (IM) routes, depending on volume and site.
- SQ angles vary, with 45-90° typically used; IM injections are given at a 90° angle.
- The "three checks" and "six rights" ensure safe medication administration.
- Preparation involves hand hygiene, patient identification, and explaining the procedure.
Intradermal Injections
- Administered in the dermal layer with a 25-27 gauge needle.
- Used for allergy testing or immunization; maximum volume is 0.1 mL.
- Observe for changes in skin integrity post-injection.
Subcutaneous Injections
- Delivered into loose connective tissue, typically 0.5-1.5 mL in adults.
- Use a 25 gauge needle at a 90° or 45° angle depending on patient size.
- Rotate sites to avoid complications like lipohypertrophy.
Intramuscular Injections
- Fastest absorption route; volumes of 2-3 mL for adults and less for children.
- Requires anatomical landmarking for correct needle placement.
- Use landmarks like deltoid, vastus lateralis, and ventrogluteal for guidance.
Ampule and Vial Preparation
- Ampules hold single doses; ensure no air enters during preparation.
- Vials may be single or multi-dose; sterile technique needed to prevent contamination.
- Always cleanse vial tops and avoid touching plunger surfaces.
Safety and Contamination Prevention
- Use sterile fields and proper disposal methods for needles to avoid injuries.
- Never recap needles after use, and perform proper hand hygiene.
- Do not inject into visibly contaminated areas or above IV sites.
Reaction Management
- Monitor for mild to severe reactions post-injection, ranging from localized symptoms to anaphylaxis.
- Provide appropriate interventions based on severity of reactions encountered.
Cast Removal Techniques
- Use oscillating saws for rigid materials, ensuring patient reassurance during the process to mitigate anxiety.
- Proper technique and patient education are essential for safe and effective care.### Indications for Catheterization
- A sterile urine sample collection.
- Urinary output monitoring, especially in critically ill patients.
- Urinary drainage for patients who cannot do so voluntarily.
- Bypassing urethral, prostate, or bladder neck obstructions due to disease or trauma.
- Supporting urethral skin grafts post-repair of urethral strictures.
- Controlling bleeding after prostate surgery using traction.
- Specialized 3-way catheters for bladder irrigation post-surgery to prevent clots.
Types of Catheters
- Straight Catheter (Robinson): Used for sterile urine samples or bladder decompression.
- Intermittent Catheterization: Specifically for patients with neurogenic bladders.
- Foley Catheter: Remains in place with an inflatable balloon; ideal for prolonged use.
Contraindications
- Presence of blood at the urethral meatus in cases of pelvic trauma.
- Allergies to materials such as latex, rubber, or lubricants.
Complications of Catheterization
- Urethral dilation from long-term use leading to leakage and increased catheter size.
- Structural trauma during catheter insertion.
- Urinary tract infections (UTIs) and inflammation.
- Challenges in performance due to urethral stricture disease or enlarged prostate.
- Creation of false passages or catheter U-turns at obstruction sites.
- Improper securing/taping of the catheter leading to patient-caused trauma.
Physiological Overview
- Urine is produced by the kidneys, transported through ureters, stored in the bladder, and excreted via the urethra.
- Catheterization involves inserting a device into the bladder through the urethra, with females needing shorter distances than males due to anatomical differences.
Patient Preparation and Education
- Set clear expectations for the procedure and ensure patient comfort to maintain a sterile field.
- Instruct the patient to remain still and avoid contamination of the sterile area.
- Female patients typically lie supine with abducted legs during the procedure.
Necessary Materials for Catheterization
- Sterile tray, collection vessel, gloves, lubricant, antiseptic solution (Betadine), gauze, and sterile forceps.
- Syringe with sterile water for the catheter balloon and various catheter types (Robinson or Foley).
- Sterile drapes to uphold the sterile field and nonsterile drapes for patient modesty.
Catheter Types and Sizing
- Catheter sizes are measured in French (Fr), with common ranges being: Pediatric boys (5-12 Fr), Adult males (16-18 Fr), and Adult females (14-18 Fr).
- Larger sizes (20-30 Fr) may be used for evacuating blood clots after prostate surgery.
Catheterization Procedure - Male
- Utilize sterile technique, ensuring lubricant application and cleaning with antiseptic.
- Insert the catheter gently, encountering slight resistance at the sphincter.
- Maintain a steady hand while inserting, and allow urine flow to measure volume if needed.
- Inflate the Foley balloon to secure catheter placement post-collection.
Catheterization Procedure - Female
- Follow similar steps of lubrication and antiseptic cleaning prior to catheter insertion.
- Insert the catheter until urine starts flowing or as needed.
- If using a Foley, inflate the balloon once urine begins to flow to ensure proper placement.
Follow-Up Care
- Monitor for signs of irritation or infection post-catheter removal, such as burning upon urination.
- Instruct the patient to observe for symptoms like dysuria, hematuria, pyuria, fever, or back pain.
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Description
This quiz covers the indications for the use of central lines, including scenarios where peripheral venous access is inadequate and situations requiring long-term IV therapy. Explore important concepts such as hemodynamic monitoring and venous access for device placement. Test your understanding of central line applications in various medical contexts.
