NUR 342 Exam 3 (CVAD, parenteral nutrition) Questions and Correct Answers
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Course
NUR 342
Institution
NUR 342
Central Venous Access Device (CVAD) provide access for a variety of IV fluids, medications, blood products, and TPN solutions and allow means for hemodynamic monitoring and blood sampling through a vein directly into the heart
-tip of catheter terminates in central venous circulation, usually in s...
NUR 342 Exam 3 (CVAD, parenteral
nutrition) Questions and Correct
Answers
Central Venous Access Device (CVAD) ✅provide access for a variety of IV fluids,
medications, blood products, and TPN solutions and allow means for hemodynamic
monitoring and blood sampling through a vein directly into the heart
-tip of catheter terminates in central venous circulation, usually in superior vena cava
Common indications for cvads ✅-chronic disease
-long term IV therapy
-chemotherapy
-frequent venipuncture
-difficult access
-frequent blood transfusions
-long term parental nutrition
-hemodynamic monitoring
When to use a peripheral access... ✅-sites are available
-therapy is short (less than one week)
-any medications given are safe via peripheral route
(vesicant or irritant drug)
(drugs with ph between 5.0 and 9.0)
(drugs with osmolarity <500mosm/L)
When to use a CVAD.... ✅-IV access is needed, but peripheral sites are not possible
-extended length of therapy
-medications are not appropriate for peripheral administration
Ex: chemo, vasoactive medications to increase BP
Confirming placement ✅use radiographic confirmation to confirm position in heart
before use
*recommended to use an ultra sound during placement to avoid complications*
PICC ✅peripherally inserted central catheter into a central vein
Radiographic verification is always required before use
May have single of multiple lumens
Less risk of complications and pneumothorax from PICC
,Catheter decisions based on time ✅less than 2-3 weeks = percutaneous catheter
1-6 months = PICC
>6 months = tunneled or implanted port
Nontunneled percutaneous central venous catheters ✅-shorter dwell time (2 weeks)
-introduced through internal jugular, subclavian, or femoral veins
-only used in emergency settings, high risk for complications
Tunneled central venous catheter ✅-tunneled into SQ tissue under the skin
-initially sutured into place (after 14 days sutures are removed)
-Tissue attaches to Dacron polyester cuff around the catheter and helps to stabilize and
minimize infection
-can be inserted using fluoroscopy or ultrasound so confirmation of xray is not needed
-can only be done by physician
Implanted Port ✅-used long term
-proximal end of port is implanted into SQ pocket of chest wall
-when not in use no external parts of port are visible
-require minimal care but have great discomfort for pt
-lowest risk for infection
-surgery required for catheter removal
Advantages of CVAD's ✅-can be left in place longer than peripheral IV line
-lower infection rate
-can accommodate multiple/types of infusions
-decreased venipuncture for pt
-PICC lines may be inserted by a specially trained nurse (cost effective)
-implanted port is invisible
Disadvantages of CVAD's ✅-risk for infection
-occlusion
-visible
-catheters placed in the jugular of subclavian veins have limited access time
-phlebitis
-vein sclerosis
-migration
-skin erosion
-infiltration
-extravasation
Flushing protocol for CVAD ✅10cc syringe with 10cc of NS
Flush daily and before and after any medication administration
*use 10cc syringe bc 3 cc syringe creates too much pressure*
Lock line with: ✅10cc syringe with 3cc heparin to lock line if not in use
, Complications that may occur with CVAD insertion or during use: ✅-blocked or difficur
infusion of fluids (occlusion)
-pain and erythema at insertion site
-blood/fliud leakage
-FVE,FVD
-electrolyte imbalance
-air.pulmonary embolism
-malpositioning
Occlusion ✅no blood return
Unable to flush
Neck or shoulder edema
Discomfort in arm, shoulder, neck
Interventions for occlusion ✅-assess tubing
-re position client
-C+DB (cough and debreath)
-Raise arm
-x-ray
-trombolytics if ordered/clot aspiration
Bleeding or Leaking interventions ✅-check for cause
-check connections
-apply sterile gauze w/ pressure
-removal/reinsertion
Infection interventions ✅-blood cultures of tip
-removal of line
-ABX
-new line in different area
*aseptic technique, dressing change every 8 days to prevent infection*
Interventions for FVE ✅adjust rate/stop infusion
Medications
Chest xray
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