Infusion Therapy for Lifespan Test #1

midline catheter

Inserted through the veins of the upper arm; Used for therapies from 1-4 weeks but no recommendations for optimal dwell time; Strict sterile technique used for insertion and dressing changes for midline catheter; Have been found to reduce the number of re

what are indications for a midline catheter?

fluids for hydration and drug therapy that is given longer than 6 days and up to 4 weeks, such as antibiotics, heparin, steroids, and bronchodilators.

where vein is used for a midline catheter?

Median antecubital vein is used most often if insertion is done w/o ultrasound guidance - If ultrasound is used for guidance of deeper veins, basilic vein is preferred over cephalic vein because its larger diameter and straighter path.

what are contraindications or things NOT TO DO with midline catheters?

(1) Should NOT be used for infusion of vesicant medications (drugs that cause severe tissue damage if they escape into subQ tissue - extravasation).
(2) DO NOT draw blood from them routinely.
(3) Should NOT be placed in extremities affected by mastectomy

where are vascular access devices (VADs) placed?

in the central circulation, specifically within the superior vena cava near its junction at the right atrium

PICCs

Long catheter inserted through a vein of the antecubital fossa or the middle of the upper arm (nurses have to be specially trained to insert these); Can be single, double or triple lumen; Sterile technique is used for insertion to reduce risk for CR-BSIs;

when should a PICC be inserted?

early in the course of therapy before veins of the extremity have been damaged from multiple venipunctures and infusions.

what is the preferred insertion site for a PICC?

Basilic vein

what are common complications with PICCs?

phlebitis, thrombophlebitis, DVT, and CR-BSIs.

what do you teach the patient about their PICC?

when performing regular ADLs just be cautious and avoid excessive activity

non-tunneled percutaneous central venous catheter (CVCs)

Inserted through subclavian vein in the upper chest or he internal jugular veins in the neck using sterile technique; Most commonly used for emergent or trauma situations, critical care, or surgery; Short-term use only; For insertion, pt has to be in Tren

tunneled central venous catheter

VADs that have a portion of the catheter lying in a subQ tunnel, separating the points where the catheter enters the vein from where it exists the skin - intended to prevent the organism on the skin from reaching the blood stream; Surgical techniques for

implanted ports

very different from other VADs; subQ pocket is surgically created to house the port body; the catheter is inserted into the vein and attached to portal body; septum is a self-sealing silicone piece that is located in the center of the portal body over the

what is the implication for an implanted port?

chosen for pt who is expected to require IV therapy for more than a year

what is important to teach the pt about maintaining an implanted port?

has to be flushed after each use and at least once a month between courses of therapy, to prevent clot formation in the internal chamber of the port (locking or de-accessing).

hemodialysis catheters

Very large lumens to accommodate the procedure; They may be tunneled for long-term or non-tunneled for short-term; Critical to the management of renal failure and must function well.

what are common complications of hemodialysis catheters?

CR-BSIs and vein thrombosis

what should hemodialysis catheters NOT be used for?

for administration of other fluids or drugs (except in an emergency)

in r/t IV therapy, what should you teach your pt?

Type of catheter being used. Hand hygiene and aseptic technique for care of catheter. Therapy required. Activity limitations. Any S/S of complications.

how do you change a dressing of the catheter?

remove it by pulling laterally from side to side. NEVER pull it off by pulling away from the insertion site because it could dislodge the catheter.

what is the purpose for flushing catheters?

Prevents contact between incompatible drugs and maintains patency of lumens (NS used).

what type of catheter should be used for obtaining blood samples?

central venous catheters and midline catheters

when removing the VAD, if you feel resistance, what do you do?

always stop and NEVER apply force to the catheter.

when removing a VAD, what can extra force do to the catheter?

Extreme traction or force can cause the catheter to break and embolize (travel) to the heart or pulmonary circulation.

what type of info do you document r/t IV therapy?

Date, time, initial, vein used, type of VAD used, type of dressing applied, how patient tolerated the procedure, etc.

infiltration

leakage of a non-vesicant IV solution or med into the extravascular tissue

extravasation

leakage of a vescicant IV solution or med into the extravascular tissue

phlebitis

inflammation of the vein

thrombosis

blood clot inside vein

thrombophlebitis

presence of a blood clot and vein inflammation

venous spasm

sudden contraction of vein

circulatory overload

disruption of fluid homeostasis in the circulatory system

speed shock

systemic reaction to the rapid infusion of a substance unfamiliar to the patient's circulatory system

catheter embolism

shaving or piece of catheter breaks off and floats freely in vessel

catheter migration

movement of a properly placed catheter tip to another vein

catheter dislodgment

movement of catheter into or out of insertion site

catheter rupture

catheter is broken, damaged or separated from hub or port body

lumen occlusion

catheter lumen is partially or totally blocked

catheter-related bloodstream infection (CR-BSI)

pathogenic organisms invade the patient's circulation; early s/s are fever, chills, headache, and general malaise