IV Mini-Bag Medication Administration

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Questions and Answers

What should you do if the medication being administered is incompatible with the infusing solution?

Increase the infusion rate of the current solution.

Use a different lumen of the CVAD if available. (correct)

Flush the current lumen with heparin before administration.

Administer the medication without any changes.

What is the minimum amount of saline that should be flushed after administering a medication through a CVAD?

5 ml

10 ml (correct)

15 ml

20 ml

If blood cannot be aspirated from a CVAD port, what should be the next step?

Do not use the port and notify the primary care nurse. (correct)

Attempt to administer medication anyway.

Continue to use the port cautiously.

Flush the port with additional saline.

What is one of the first actions to take before changing a CVAD insertion site dressing?

Gather a sterile dressing tray and supplies. Signup and view all the answers

What is the purpose of using a biopatch during a CVAD dressing change?

To promote healing around the insertion site. Signup and view all the answers

What is the purpose of using the push-pause technique when flushing the CVAD line?

To prevent air embolism in the patient Signup and view all the answers

What should be done immediately after administering the medication through a CVAD?

Chart the administration of the medication Signup and view all the answers

Which of the following actions is NOT part of the pre-steps for administering IV push medication?

Attach the medication IV tubing to the port Signup and view all the answers

What is the role of the 'change-date' sticker on IV tubing?

To mark when the tubing needs to be replaced Signup and view all the answers

What should be done if blood return is not observed while verifying patency of the CVAD?

Consult the healthcare provider for further instructions Signup and view all the answers

What is the first step in the process of administering IVBP medication through a CVAD with an infusing IV solution?

Verify appropriateness of medications and patient allergies Signup and view all the answers

What is done to ensure the primary IV has resumed infusing after administering the IVBP medication?

Check that the primary line is infusing properly Signup and view all the answers

What is one of the last steps after completing the administration of an IV push medication?

Clean the CVAD site and reapply a new cap Signup and view all the answers

What is the first step that must be taken before beginning a dressing change?

Perform hand hygiene Signup and view all the answers

When should a gauze dressing be changed?

Every 48 hours Signup and view all the answers

What is the purpose of placing the patient in Trendelenburg position during CVAD removal?

To prevent air embolism Signup and view all the answers

What should be applied to the site if there is drainage present after cleaning?

2x2 gauze Signup and view all the answers

What must be assessed before proceeding with the removal of a CVAD?

Patient's recent use of anticoagulants Signup and view all the answers

What is an important sign to monitor for after catheter removal?

Increased heart rate Signup and view all the answers

Which step is NOT part of the procedure for changing a dressing?

Prepare the patient for a physical exam Signup and view all the answers

What must be done if the catheter removed is longer than 8 french?

Do NOT proceed with the removal Signup and view all the answers

Study Notes

Administering IV minibag med through locked CVAD

Pre-Steps
- Ensure mini-bag is at room temperature
- Check CVAD tip placement
- Gather supplies: alcohol wipes, 2 x 10 ml syringes of normal saline (NS), sterile cap, IV tubing, "change-date" label, medication
- Clamp tubing, spike bag, prime line, set up pump, put change-date sticker on line (24 hour)
- Identify patient, evaluate CVAD site, scan medications
Med Admin
- Remove cap and clean connector on CVAD
- Verify patency of line: attach 10 ml NS, unclamp (if needed), aspirate for blood return, flush 5-10 ml using push-pause method
- Disconnect and rescrub
- Attach medication IV tubing to port
- Run pump at the correct rate and volume,
- Chart, medication complete
- Clamp tubing, disconnect from CVAD, cap end of IV tubing with a new cap
- Flush: Attach 10 ml NS, unclamp (if needed), flush 5-10 ml using push-pause method
- Attach new cap to CVAD line

Administering IVBP med through a CVAD when IV solution is infusing

Pre-Steps
- Verify appropriateness of medications and patient allergies
- Confirm placement of CVAD
- Obtain new secondary IV tubing and add change-date sticker (24 hour)
- Spike bag, clamp tubing, prime line with backflush method, set up pump, put change-date sticker on line
- Identify patient, evaluate CVAD site, scan medications
Med Admin
- Remove cap and clean highest port of primary tubing
- Attach tubing and backflash if not already done
- Set pump at the correct rate and volume, begin infusion
- Chart, medication complete
- Do NOT disconnect empty med bag or secondary tubing
- Check to ensure primary has resumed infusing

Administering IV push med through an IV lock on a CVAD

Pre-Steps
- Verify appropriateness of medication, patient allergies, hold parameters
- Confirm placement of the CVAD
- Gather supplies: alcohol wipes, 2 x 10ml syringes of normal saline (NS)
- Scan medication
- Draw up medication
- Identify patient, evaluate CVAD site
Med Admin
- Remove cap on CVAD site, clean
- Verify patency of line: attach 10 ml NS, unclamp (if needed), aspirate for blood return, flush 5-10 ml using push-pause method
- Remove syringe, clean again
- Attach medication syringe and administer at ordered rate
- Remove when complete and clean
- Flush: flush with 10 ml NS with the first 2-5 ml being at the same rate as the medication, remainder injected with the push-pause technique
- Lock lumen per policy
- Apply new cap
- Chart

Administering IV push med through a CVAD with an infusing solution

Pre-Steps
- Verify appropriateness of med, pt allergies, hold parameters
- Confirm placement of the CVAD
- Gather supplies: alcohol wipes, 2 x 10 ml syringes of NS
- Scan med
- Draw up med
- Identify pt, evaluate CVAD site
- Important Note: If medication IS compatible with the infusing solution, you DO NOT need NS flushes. If incompatibility exists, you WILL need flushes before and after medication administration
Med Admin
- Remove cap and clean lowest port of IV tubing connected to CVAD
- If medication is compatible: administer at the correct rate
- If medication is incompatible:
  - Use a different lumen of CVAD if one is available
  - If a different port is NOT available:
    - Stop infusion, clamp tubing, scrub and flush lowest port on IV tubing with 5-10 ml NS
    - Scrub again, administer medication at the proper rate
    - Flush: flush with 10 ml NS with the first 2-5 ml being at the SAME rate as the med, remainder injected with the push-pause technique.
- Restart infusion pump and resume infusion

Important Notes

Assess and flush unused ports on CVAD every shift and ideally within 2 hours of starting
If unable to aspirate blood or flush a port, DO NOT use it. Notify the primary care nurse (PCN) of the inability to flush and chart
CVAD tip location must be verified before use
Implanted ports should be heparin locked
You can use the same line for up to 24 hours if the medication is compatible

CVAD Insertion Site Dressing Change

Supplies
- Sterile CVAD dressing tray: mask, sterile gloves, chlorhexidine, tape, 2 x 2 dressing, skin protectant, transparent dressing
- Biopatch
- Sign indicating "Sterile procedure in progress"
- Long sterile applicators (Q-tips)
Pre-Steps
- Gather supplies
- Place the "Sterile procedure in progress" sign on the door
- Explain the procedure to the patient and ask about allergies
- If the patient has a cough, they need to wear a mask. Anyone in the room needs to wear a mask
Procedure
- Hand hygiene, open kit, put on mask, put on NON-sterile gloves, remove old dressing
- Inspect site
- Remove gloves and discard with the old dressing
- Hand hygiene
- Open biopatch and Q-tips and drop into the kit
- Put on STERILE gloves
- Clean area with chlorhexidine
- If there is drainage, place a 2 x 2 gauze over the site, if no drainage use biopatch
- Apply skin protectant
- Apply transparent dressing
- Secure tubing with tape
- Remove gloves and mask
- Hand hygiene
- Fill out label with dressing change date and initial
- Document

Dressing Change Notes

Dressings with gauze should be changed every 48 hours
Transparent dressings should be changed every 5-7 days

Removing Centrally Inserted (Subclavian or Jugular) CVAD

Supplies
- Suture removal kit
- Chlorhexidine sponge
- Vaseline gauze
- 4 x 4 and 2 x 2 gauze
- Transparent dressing
- Nonsterile gloves
Pre-Steps
- Verify order
- Gather supplies
- Ensure patient has a functional IV unless no IV access is needed
- Check CVAD hub for catheter size and length: DO NOT proceed if catheter is larger than 8 French
- Assess for signs of intravascular thrombus: edema of upper extremities, face, neck, dizziness
- Assess patient coagulation labs and recent use of anticoagulants. Caution if counts are low
- Explain the procedure and assess patient ability to lay flat and perform Valsalva
Procedure
- Turn off the infusion (if needed), clamp
- Hand hygiene, put on nonsterile gloves
- Open suture removal kit and remove tweezers
- Maintaining sterility, assemble 4 x 4, 2 x 2, and vaseline gauze
- Place patient in Trendelenburg position
  - If not tolerated, want the head of the bed (HOB) at least less than 30 degrees
- Remove dressing and inspect insertion site
- Discard dressing and gloves
- Hand hygiene and new nonsterile gloves
- Remove sutures
- Cleanse area with chlorhexidine
- Carefully place gauzes onto the site
- Have the patient perform Valsalva and remove the catheter
- Apply direct pressure for 5 minutes, 10 minutes if on anticoagulants
- Monitor for signs of air embolism: respiratory distress, chest pain, decreased level of consciousness (LOC), tachycardia, hypoxia, hypotension
  - If suspected, call for help, ensure site is occluded, place patient in left side Trendelenburg, and place a high flow oxygen.
- Inspect the catheter for length, deficits, jagged edges, etc.

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Description

This quiz covers the essential steps for administering IV medication through a locked central venous access device (CVAD). It includes pre-administration procedures, medication administration techniques, and proper post-administration protocols. Test your knowledge on the standards of care and best practices for safe IV therapy.