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NURS 611 Exam 1 Study Guide Advanced Pathophysiology
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NURS 611 Exam 1 Study Guide Advanced Pathophysiology
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NURS 611 Exam 1 Study Guide AdvancedPathophysiology
purpose of IV therapy - ANSWER hydration
nutrition
med administration
choosing vascular access - ANSWER based on medications needed to be
administeres, length of stay/care w/ goal of minimizing # of accesses, attempts, and
risk for adverse reaction
access standards of care - ANSWER location
gauge size
# of attempts
chlorhexidine
bacteriostatic dressings/caps
scrub hub (15 seconds)
site check
environment
flushing (3-5cc PIV, 10cc CIV)
blood return
continuous IV site check - ANSWER performed q/h
intermittent IV site check - ANSWER performed Q8H and/or prior to med
administration
tubing standards of care - ANSWER never leave tubing uncapped
change continuous tubing Q96H
change TPN tubing Q24H
change blood product tubing every unit
peripheral IV - ANSWER short term catheter inserted into any vein that is not in the
chest or abdomen
function: non irritating and non vesicant meds
dwell time: therapy > 5 days
peripheral IV sites - ANSWER cephalic, basilic, saphenous, external jugular,
antecubital, dorsal venous, scalp
care of peripheral line - ANSWER assess, flush for patency, maintain dressing,
removal
catheter sizes and flow rates - ANSWER
midline catheters - ANSWER "long peripheral line"// sterile
location: terminates in area of axillae
,meds: blood draw
dwell time: up to 4 weeks
midline catheter sites - ANSWER basilic and cephalic veins
midline catheter uses - ANSWER blood draw
PPN
pts with difficult IV access
Central intravenous therapy - ANSWER Used to infuse fluids due to rapid
hemodilution in the SVC.
1. Ensure X-ray verification of tip prior to use
2. Insertion occurs in the OR, the clients room, or outpatient facility using sterile
technique.
3.Tunneled and implanted catheters require surgical removal
4. Types: nontunneled, percutaneous central venous catheters (CVC), PICC,
tunneled central venous catheters (Hickman, Groshong).
Nontunneled percutaneous central venous catheter (CVC) - ANSWER Description:
18 to 25cm (7-10 inch) in length w/ 1-5 lumens.
Length of use: short-term (<6w)
Insertion location: SV, JV; tip in the distal
Indications: emergent or trauma use, admin of blood, admin of chemotherapeutic
agent, antibiotics, and TPN
Tunneled percutaneous central venous catheter - ANSWER For long-term use
Insertion: A portion of the catheter lies in a subcutaneous tunnel separating the point
where the catheter enters the vein from where it enters the skin with a cuff. Tissue
granulates into the cuff to provide a mehhanical barrier to organisms and anchoring.
Indications: Frequent-long term need for vascular access
Groshong catheters have pressure-sensitive valves to prevent blood reflux and do
not require a clamp.
central line flushing - ANSWER some (open ended catheters) require heparin
flushes to prevent clogging with fibrin; while some (valved catheters) do not
PICC line - ANSWER Description: 45-74 cm (18-29 inch) with single or multiple
lumens. Length of use 12m
Insertion: basilic or cephalic vein at least one fingerbreath above or below the AC
fossa. Should be advanced until tip is in the lower 1/3 of the SVC.
Indications: Administration of blood products, long-term admin of chemo, antibiotics,
and TPN (vesicant therapy
meds with pH <5 or >9
long term fluid therapy (>4 weeks)
parenteral nutrition glucose ?10%)
when possible insert early before veins are exposed to various venous punctures
PICC line Considerations - ANSWER Preprocedural:
,Ensure informed consent has been signed
Cleanse the site with chlorhexidine
Ensure sterility of equipment
Place STOP sign to restrict entry during procedure
Postprocedural:
confirm placement with X-ray. Asses the site for redness, swelling, drainage,
tenderness, and condition of the dressing
Clean insertion port with alcohol for 15 seconds (or use valve disinfection caps.
Use transparent dressing (change q/7)
NO BP IN ARM WITH PICC & DO NOT GET WET.
PICC line indications - ANSWER infection
endocarditis
hyperemesis
osteomyeltits
cancer
pancreatitis
bowel obstruction
nutritional support
PICC line care - ANSWER -Use a 10mL for PICC (do not exceed resistance)
-Flush before and after med admin (10 mL)
-Flush 20mL 0.95 sodium chloride after blood products
-Flush 5 mL heparin when not in use
systemic bacteremia - ANSWER pt w/ this infection must have - bcxs for 48hrs
before a picc can be placed
lumens - ANSWER each provides independent access to venous circulation to allow
incompatible drugs or fluids to be infused simultaneously
infusion valve - ANSWER opens with minimal pressure and automatically closes
after infusion
aspiration valve - ANSWER opens for sampling and automatically closes to resist
pressure fluctuations that may cause reflux
closed valve - ANSWER remains closed during normal increases in CVP to prevent
reflux. No heparin needed
valved catheters - ANSWER no need for heparin flush since valve is closed when
not being used so fibrin is less likely to clog line; requires 10mL NS flush per day or
before and after use instead
three way valve - ANSWER a valve with three ports (one inlet and two outlets) used
to divert flow direction and allows for blood draw
implanted ports - ANSWER Description: Small reservoir covered by a thick septum
, Insertion site: surgically implanted into the chest wall. Catheter inserted into the
Subclavian and terminates in the SVC.
Indications: Long-term- 1yr or more need for vascular access (chemotherapy)
implanted ports care - ANSWER Specific trained individuals wearing a mask and
aseptic technique during access.
-Apply topical anesthetic
-Acess with Huber needle
-Check blood return prior to med admin.
-Flush with heparin 10 units m/L or 0.9% sodium chloride after every use and at least
q/m
require:
weekly dressing change
needle change with each dressing
Mechanical Complications - ANSWER Dislodged catheter tip& or port. Use only
noncoring (huber) needle to avoid damaging the mesh of the port. Manifestations of
dislodged port include swelling, unrestricted movement of the port, and inability to
access.
Manifestations of dislodged catheter tip include gurgling/swishing sounds, pain on
affected side (neck or ear).
central line care - ANSWER determine NEED
verify placement (measurement)
dressing changes once a week
line length
flushing
risks
local complications - ANSWER hematoma (bruise)
inflitration
extravastation
phlebitis
thrombophlebitis
infection
systemic complications - ANSWER anaphylaxis (Latex products * typically)
air embolism
catheter embolism
sepsis
air embolism - ANSWER a bubble of air in the bloodstream; prevent by clamping,
keeping lines capped, appropriate use of IV pump, and priming your tubing
infiltration s/s - ANSWER edema, swelling, blanching, coolness, tenderness,
discomfort
infiltration interventions - ANSWER stop infusion
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