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IV therapy- exam 4

front 1 central venous catheters (cvc)	back 1 percutaneous line most commonly used central line in hospital single, double, triple, or quad lumen typically <60 day use (shorter term use)
front 2 what veins are used for central venous catheter?	back 2 internal jugular vein or subclavian veins are most commonly used sutured in place
front 3 tunnel catheters	back 3 percutaneous, tunnled under the skin single, double, or triple lumen long term use- 1 year placed surgically in OR, cannot be placed at bedside
front 4 tunnel catheters placement	back 4 2 surgical wounds- tunnel is made from surgical site near the subclavian area to an exit wound further down the chest a cuff will form a barrier under the skin- stabilizes the catheter & prevents bacterial migration into the blood stream

front 5 peripherally interred central catheters (PICC)	back 5 place peripherally but are considered a central line- threaded to the superior vena cava (SVC) can be 20x longer than a peripheral catheter- fed up the arm often inserted through the basilic vein MUST BE CONFIRMED BY X-RAY PRIOR commonly used for long term antibiotics; TPN can be used for 6 weeks
front 6 PICC line flush	back 6 requires daily flush can be NS or NS and heparin when flushing you MUST use a 10ml syringe due to pressure can be inserted at bedside
front 7 implantable ports: port-a-cath (PAC/POC)	back 7 a port is placed in a surgically made "pocket" and sutured in place a catheter extends into a vein from this port requires a huber needle to access can be single or double port/lumen needle should be changed every 5-7 days can be used for 1 year commonly used for chemotherapy
front 8 tesio catheters	back 8 for hemodialysis use ONLY do NOT access, flush, aspirate or administer medications via a tesio for dialysis staff only often used while an AV fistula is being place requires heparin

front 9 caring for central lines	back 9 scrub the hub for at least 15-20 seconds can use scrub caps, alcohol, chlorohexidine antibacterial caps should be applied to each port between do not reuse cap
front 10 systemic complications	back 10 problem involving the entire body related to IV therapy ex: circulatory overload, infection, sepsis
front 11 local complications	back 11 adverse reaction or trauma to the surrounding site ex: phlebitis, hematoma
front 12 hypersensitvity complications	back 12 can be systemic or local

front 13 more in depth - systemic complications	back 13 circulatory overload usually infused too fast, or with hepatic, cardiac, renal disease dyspnea, cough, edema, wt gain, rales or crackles infection (sepsis/septicemia)
front 14 systemic complications -more in depth	back 14 venous air embolism (rare, lethal) air gets trapped in R ventricle and lodges against the pulmonary valve
front 15 s/s of systemic complications	back 15 tachycardia SOB shoulder pain JVD hypotension weak pulse dizziness
front 16 venous air embolism, what would you do if your patient has this?	back 16 immediately place patient on left side- trendelenburg- this will cause air to disperse back to the right atrium and prevent air from entering the pulmonary artery apply oxygen obtain vitas, pusle oximetry notify HCP

front 17 speed shock associated with systemic complications	back 17 medication is rapidly introduced into circulation usually results in hypertension slow the infusion rate, notify HCP ex: vancomycin- red man syndrome
front 18 local complications phlebitis	back 18 inflammation of vein s/s- redness, pain, swelling, induration remove IV &relocate stop infusion warm compress
front 19 local complications infiltration	back 19 seeping of fluid into surrounding tissue site will be cool to touch with dependent edema; painful discontinue IVFS, remove IV, apply cold compress and elevate the extremity check site hourly
front 20 local compllciaitons extravasation	back 20 infiltration of a vesicant medication can cause blistering and sloughing of tissues chemo potassium dopamine flagyl stop infusion aspirate medication if possible apply old compress

front 21 local complications hematoma	back 21 infiltration of blood into extravascular tissues may see discoloration of skin usually related to nursing skills higher risk of patients on anti-coagulants higher risk in elderly
front 22 prevent complications	back 22 handwashing use sterile technique inspect all equipment before use anchor IV tubing and cannulas to prevent motion and pulling do not use veins over areas of joint flexion if possible be alert to sings of circulatory overload JVD, elevated BP, elevated RR, crackles, edema, weight gain
front 23 LPN scope of practice	back 23 guidlines are provided by state board of nursing always follow your facility policy as well may insert, flush and discontinue any peripheral iv line check facility policy when working with any central line in order to follow your scope cannot discount or insert any central line cannot access or flush ports