What are the two drugs used in PCAs? What is the minimal acceptable respiratory rate?
Morhine and Hydromorphone
RR: 12
List the 4 things to document with PCAs
1. Number of doses attempted
2. Number of doses delivered
3. Total mg of analgesic delivered
4. Amount of solution in infusion left at end of shift
List indications for Central VADs
1. Multiple infusions
2. TPN & Lipids
3. Blood draws
4. Lengthy abx tx
5. Poor peripheral IV access
6. Irritating Vesicant solutions
7. Chemo
8. Chronic dz
9. Need for CVP
T or F: ALL central lines must be flushed with 5 mL of NS
False: 10mL
The best technique for flushing a central line to prevent fibrin build up in the cath is the:
D.
Are Percutaneous Caths short term or long term VADs type?
How long can they stay on for depending on the site or use:
1. Chest or Neck Central line
2. Femoral Line (Hours)
3. Quinton Cath
4. Midline Cath
5. PICC (weeks)
(Quinton Cath: non-tunneled central line catheters, which are often used for acute (i.e. temporary) access for hemodialysis or infusion of medicine)
Short term
1. 5-7 days
2. 48 hours
3. 5-7 days (Acute dialysis)
4. 28 days
5. 6-8 weeks
Why are femoral lines so risky to use?
It is a high risk for bacteria
This type of catheter is generally only for acute dialysis. Where is it placed? How long is it used for?
What is the nursing consideration for this cath?
Quinton Cath: placed in subclavian, internal jugular, or femoral vein
Used for 5-7 days
It is specialized for dialysis nurse ONLY. It is flushed with high dose of heparin d/t being a large bore cath.
This type of cath is best used for quick access, doesn't need a PICC but requires a longer duration than a peripheral line.
How long is it used for?
Where is it placed?
How long are they usually?
Indications?
Midline Cath: 28 days
Placed in upper arm vein
Usually 20 gauge
Best used for quick access but doesn't need PICC line, but longer duration than a short peripheral. (Also if pt. has a pacemaker)
T or F: Midline cath insertion is inserted in the upper arm vein
true: it is easier to dislodge d/t short length of 20cm
T or F: You can use midline caths for lab draws
False: usually has a small lumen (20 gauge) that cannot be used for lab draws
What are the disadvantages of midline caths?
1. No vesicant solutions
2. No TPN
3. Need adequate peripheral veins
What are the three uses of Groshong Valves?
What is its purpose?
1. PICCs
2. Tunneled Caths
3. Ports
It has a special tip: two-way valve that restricts backflow of blood.
(Flush with saline only)
T or F: You flush Groshong Valves with saline only
True
List indication for a power line/pick (purple colored hub)
Useful for diagnostics with rapid contrast dye, preventing a breech in the line.
This type of valve has a two-way valve, has a silastic material, and can be used in PICCs, tunneled caths and ports
Groshong Valve
This agent is used to declot a fibrin (thrombotic) occlusoin:
B.
This agent dissolves precipitates in VADS maintenance:
C.
This maintenance VADS agent is a patency anticoagulation lock:
D.
Are implanted ports long or short term VADs?
How do you know if there is a power port implemented
Long: It is sutured in the skin. It will have a grail to feel for that indicate there's a power port.
What is Pinch-off syndrome?
Intermittent occlusion while infusing or aspirating a cath.
Can be fixed by adjusting patient position or abducting the arm.
T or F: In short term VADs, a central venous line is tunneled under the skin (also known as "anti-microbial buff)
