Podcast
Questions and Answers
The tip of a PICC catheter should be placed in the:
The tip of a PICC catheter should be placed in the:
- Lower third of the superior vena cava (correct)
- Lower one third of the inferior vena cava
- Lower one third of the basilic vein
- Anywhere in the subclavian vein
When accessing a CVAD, always use at least a _____ sized syringe
When accessing a CVAD, always use at least a _____ sized syringe
- 5 mL
- 3 mL
- 10 mL (correct)
- 20 mL
A patient with a CVAD line complains of swishing noise in his ear when the line is flushed. This can be an indication of:
A patient with a CVAD line complains of swishing noise in his ear when the line is flushed. This can be an indication of:
- The tip of the catheter has migrated into the jugular vein
- The CVAD is patent and being thoroughly flushed
- Of a CVAD-associated infection (correct)
- Of a pulmonary embolus
Chest pain, shortness of breath, and cyanosis are signs of:
Chest pain, shortness of breath, and cyanosis are signs of:
The transparent film dressing on a CVAD insertion site is usually changed every
The transparent film dressing on a CVAD insertion site is usually changed every
Acetone may be used to remove adhesive glue from CVAD
Acetone may be used to remove adhesive glue from CVAD
After blood sampling from implanted vascular access device (port) you should always flush with a minimum of:
After blood sampling from implanted vascular access device (port) you should always flush with a minimum of:
Phlebitis may be caused by mechanical or chemical means
Phlebitis may be caused by mechanical or chemical means
If the catheter is occluded or there is resistance upon flushing or infusion the nurse will:
If the catheter is occluded or there is resistance upon flushing or infusion the nurse will:
Symptoms of local or systemic infection include the following: ( select all that apply)
Symptoms of local or systemic infection include the following: ( select all that apply)
All PICC must use a securement device:
All PICC must use a securement device:
To dissolve a clot a thrombolytic may be administered by the nurse
To dissolve a clot a thrombolytic may be administered by the nurse
If an air embolism is suspected, nursing actions include: ( select all that apply)
If an air embolism is suspected, nursing actions include: ( select all that apply)
Match the CVAD with the record duration of use:
Match the CVAD with the record duration of use:
A CVAd does not require radiological confirmation of placement before use
A CVAd does not require radiological confirmation of placement before use
Reasons for CVAD therapy include
Reasons for CVAD therapy include
Which finding would suggest a Central Line-Associated Bloodstream Infection (CLABSI) in a patient with a CVAD?
Which finding would suggest a Central Line-Associated Bloodstream Infection (CLABSI) in a patient with a CVAD?
A patient with a tunneled CVAD is receiving Total Parenteral Nutrition (TPN). What is the most important nursing action to prevent complications related to TPN administration?
A patient with a tunneled CVAD is receiving Total Parenteral Nutrition (TPN). What is the most important nursing action to prevent complications related to TPN administration?
When changing a transparent dressing on a CVAD, what is the primary rationale for using strict sterile technique?
When changing a transparent dressing on a CVAD, what is the primary rationale for using strict sterile technique?
A patient with a chest tube suddenly develops increased shortness of breath and has diminished breath sounds on the affected side. What immediate action should the nurse take?
A patient with a chest tube suddenly develops increased shortness of breath and has diminished breath sounds on the affected side. What immediate action should the nurse take?
A patient with a PICC line is about to receive medication. Prior to administering the medication, the nurse assesses the insertion site and notes swelling and redness. What is the nurse's priority action?
A patient with a PICC line is about to receive medication. Prior to administering the medication, the nurse assesses the insertion site and notes swelling and redness. What is the nurse's priority action?
What is the most appropriate flushing protocol for maintaining the patency of a CVAD that is not in continuous use?
What is the most appropriate flushing protocol for maintaining the patency of a CVAD that is not in continuous use?
A patient with a chest tube is being transferred from the bed to a chair. What is the most important consideration regarding the drainage system during the transfer?
A patient with a chest tube is being transferred from the bed to a chair. What is the most important consideration regarding the drainage system during the transfer?
A patient receiving TPN develops rapid weight gain, edema, and crackles in the lungs. Which complication is most likely occurring?
A patient receiving TPN develops rapid weight gain, edema, and crackles in the lungs. Which complication is most likely occurring?
During chest tube insertion, if continuous bubbling is noted in the water-seal chamber, what does this typically indicate?
During chest tube insertion, if continuous bubbling is noted in the water-seal chamber, what does this typically indicate?
A patient is being discharged home with a PICC line for long-term antibiotic therapy. What key instruction should the nurse emphasize regarding daily care?
A patient is being discharged home with a PICC line for long-term antibiotic therapy. What key instruction should the nurse emphasize regarding daily care?
Flashcards
CVAD Infection Signs
CVAD Infection Signs
Redness, swelling, warmth, pain, or drainage at the insertion site.
CVAD Flushing Frequency
CVAD Flushing Frequency
Flush before and after medication and at least once per shift if not in use.
PICC Line
PICC Line
Inserted into a peripheral vein, tip in superior vena cava; used for medium-term IV therapy.
Tunneled CVAD Placement
Tunneled CVAD Placement
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Dialysis Catheter
Dialysis Catheter
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TPN Macronutrients
TPN Macronutrients
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TPN Administration
TPN Administration
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TPN Hyperglycemia Management
TPN Hyperglycemia Management
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Chest Tube Purpose
Chest Tube Purpose
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Dislodged Chest Tube
Dislodged Chest Tube
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Capital of France (example flashcard)
Capital of France (example flashcard)
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Study Notes
General Care of CVADs
- Insertion site assessment should include looking for redness, swelling, warmth, pain, or drainage
- Check for catheter displacement, proper functioning, and any signs of occlusion
- Use sterile technique for dressing changes to minimize infection risk
- Transparent dressings are changed every 7 days or when visibly soiled or wet
- Gauze dressings are changed every 48 hours
- CVADs should be flushed with saline or heparin (as prescribed) to maintain patency and prevent clotting
- Flushing is typically done before and after medication administration and at least once per shift if the line is not in use
Complication Prevention in CVADs
- Monitor for signs of Central Line-Associated Bloodstream Infections (CLABSI), follow proper hand hygiene and sterile technique
- Monitor for swelling or pain in the limb, as this could indicate a thrombus or clot
- Be cautious when handling the line to avoid introducing air into the bloodstream
- Secure the catheter properly and monitor for any signs of an air embolism, such as sudden shortness of breath and chest pain
Patient Education for CVADs
- Instruct patients on care of the CVAD, including avoiding pulling or tugging on the catheter
- Educate about signs of complications like infection, catheter displacement, and air embolism
- Encourage patients to report discomfort or any changes at the insertion site immediately
Non-Tunneled CVAD
- Short-term use (up to 6 weeks)
- Often used in emergency or critical care settings
- Inserted directly into a large central vein (subclavian, jugular, or femoral vein)
- Higher risk of infection due to short-term nature
Tunneled CVAD
- Long-term use (weeks to months)
- Often used for chemotherapy, antibiotic therapy, or dialysis
- The catheter is tunneled under the skin before entering the central vein, providing more secure access
- Lower infection risk than non-tunneled CVADs and can be used for months, though maintenance is still required
Peripherally Inserted Central Catheter (PICC)
- Medium-term use (up to several months), especially for patients with difficult venous access
- Inserted into a peripheral vein (usually in the arm), with the tip positioned in the superior vena cava
- A good option for patients needing prolonged IV therapy, such as long-term antibiotics or nutrition
Implanted Ports
- Long-term use, typically for patients who need repeated access, such as those receiving chemotherapy
- The port is placed under the skin, and the catheter leads to a central vein
- Low infection risk and can be used for long periods without external catheter exposure
Dialysis Catheters
- Long-term use for hemodialysis
- Inserted into a large central vein (usually the internal jugular)
- Larger diameter to accommodate the high-pressure flow needed for dialysis
Indications for TPN
- Used for patients who cannot meet nutritional needs via the gastrointestinal tract
- Examples of patients who may need TPN include those with bowel obstruction, short bowel syndrome, malabsorption syndromes, or after major surgery
- Delivered through a central venous catheter (CVC) due to the high osmolarity of the solution, which could damage smaller peripheral veins
Components of TPN
- Macronutrients include glucose (carbohydrates), amino acids (proteins), and lipids (fats)
- Micronutrients include vitamins, minerals, and trace elements tailored to the patient's needs
- Electrolytes are carefully monitored to ensure a balanced nutritional profile
- The volume and composition of fluids are adjusted based on the patient's hydration status
Administration of TPN
- The infusion rate should be carefully calculated to prevent complications, such as hyperglycemia, fluid overload, or electrolyte imbalances
- TPN should be prepared in a sterile environment, and the bag should be changed daily
- Patients receiving TPN require frequent monitoring, including blood glucose levels, electrolytes, liver function tests, and weight
Complications of TPN
- The use of a CVC increases the risk of Central Line-Associated Bloodstream Infections (CLABSI), so strict infection control practices are essential
- High glucose concentrations can cause hyperglycemia, monitor blood glucose regularly, and insulin may be required
- Long-term TPN use can lead to liver dysfunction and cholestasis, especially in children or those receiving TPN for extended periods
- Careful monitoring is needed to avoid hyperkalemia, hypokalemia, hypophosphatemia, and other imbalances
Nursing Considerations for TPN
- Monitor the TPN solution for correct composition, integrity, and expiry
- Ensure the central line is functioning properly before starting the TPN infusion
- Educate the patient on the importance of consistent TPN administration and monitoring for complications
Indications for Chest Tube
- Inserted to drain air, blood, or fluid from the pleural space
- Common reasons for chest tube placement include pneumothorax (air in the pleural space)
- Further reasons include hemothorax (blood in the pleural space), pleural effusion (fluid accumulation)
- Other reasons include post-surgical drainage (especially after thoracic surgery or trauma)
Nursing Responsibilities for Chest Tubes
- Ensure the drainage system is functioning correctly (e.g., water-seal chamber) and that no air is entering the pleural space
- Assess the amount, color, and consistency of fluid in the drainage system
- Monitor for signs of infection at the insertion site (e.g., redness, warmth, drainage) and check for subcutaneous emphysema
- Monitor vital signs, particularly respiratory rate, oxygen saturation, and signs of respiratory distress
Drainage System Maintenance for Chest Tubes
- The water-seal chamber should have a small amount of water to prevent backflow of air into the pleural space
- Continuous bubbling indicates an air leak
- Suction control: If suction is ordered, check that the suction pressure is set to the correct level (typically -20 cm H2O)
- Ensure that the chest tube is free from kinks or obstructions
Complications of Chest Tubes
- Persistent air bubbles in the water-seal chamber indicate an air leak, which may prevent lung re-expansion
- Monitor for signs of increased shortness of breath
- If the chest tube is dislodged, immediately cover the site with sterile occlusive dressing and tape it in place to prevent air from entering the pleural space
- Watch for signs of infection at the insertion site, and adhere to strict aseptic technique when managing the chest tube
Patient Education for Chest Tubes
- Instruct the patient to avoid pulling on the chest tube and to notify staff if they feel any sudden pain, shortness of breath, or discomfort
- Teach the importance of deep breathing and coughing exercises to help with lung expansion and prevent pneumonia
- Explain the need to monitor the drainage and ensure that the system remains below chest level to facilitate proper drainage
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