Exam (elaborations)
CENTRAL LINES AND TPN (1)
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CENTRAL LINES AND TPN (1)
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CENTRAL LINES AND TPNhypotonic - ANS-moves fluid into cells, hydrates cells
1/2 NS
isotonic - ANS-similar to body fluids, expands extracellular space, can fluid overload
NS
LR
hypertonic - ANS-interstitial to vascular, irritating to vein, can fluid over load, glucose problems
replace electrolytes
D5NS
TPN
what happens if you don't get blood return when flushing a central line? - ANS-You should
always get blood return !
have pt cough, change position, change dressing, change caps
flush then try to pull back
what do you do if the IV has infiltrated?
if suspected - ANS-1- stop the IV
baby flush/check for blood return
If infiltrated remove the IV and document
apply heat (usually) and elevate
if you have a vesicant solution, call pharmacy because they may recommend special treatment,
possibly apply cold
Change IV sites every ______
how soon if EMT put it in - ANS-96 hours
change in 24-48 hours if EMS put in IV
IV uses
14 gauge
16 gauge
18 gauge
20 gauge
22 gauge
24 gauge - ANS-14 gauge-trauma, blood donation
16 gauge-trauma
18 gauge-OR (green)
20 gauge- usually good for all therapies including blood
22 gauge-good for most therapies, can still give blood
, 24 gauge- children, elders with small, frail veins
how to prevent complications of IV - ANS-frequent IV checks
good hand hygiene
anchor IV site well
change wet IV site dressings
central venous catheters - ANS-placed in the large veins of the pt to administer fluids, meds,
parenteral nutrition, or for the removal of blood (aphresis)
allows for long term venous access without repeated puncture
The tip of a central venous catheter rests in the: - ANS-superior vena cava (SVC)
catheter tip placement-junction of superior vena cava and right atrium. placed in an area
why would a patient require a central venous catheter? - ANS-long term therapy
chemo
auto-immune disease w/long term tx
inadequate vascular access
TPN
can use to draw blood, if frequent draws required
Tunneled Central Venous Catheter - ANS-under the skin
Hickman (most common), Broviac, Groshong
Non-tunneled CVC - ANS-PICC, triple lumens
Implanted ports (type of tunneled) - ANS-mediport
CVC used for short term
CVC used for long term - ANS-CVC used for short term: triple lumens and PICCs
CVC used for long term: tunneled lines and ports
Hickman catheter - ANS-tunneled catheter
usually decreased risk of infection because longest tube
1-2 years
inflated cuff helps keep it in place
cuff helps induce fibrin and collagen around it to stay in place and has abx in the cuff
what happens if you don't get blood return when flushing a central line? - ANS-You should
always get blood return !
have pt cough, change position, change dressing
flush then try to pull back
if there are no clamps - ANS-don't use heparin
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