Term
| Patient in the hospital is transferred form a long term care facility to the hospital for malnutrition and severe dehydration she is 90 yrs old. On examination of her skin you find it to be paper thin with several areas bruised from previous blow veins. The doctor has ordered TPN for this pt. what sort of line do you think the doctor will order for this pt and why? |
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Definition
| This patient will recieve a central venous line because they have limited vascular access (blown veins, age and dehydration contributing to this) and will have to have TPN which is a hypertonic solution (there-for to costic to put in a periferal site.) |
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Term
| You walk into the patients room and they are laying in bed with a large portion of there chest covered in blood. As you rush to inspect you find blood freely pulsing from a broken lumen on a central line. What should you do |
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Definition
| get a hemastate out and clamp the line closed on the luman above the break then call for help (doctor and other nurses) |
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Term
| Why do we inspect the end of catheters when they are removed? |
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Definition
| to insure that it is completely intact (no peice of it has broken off and is now floating about the circulatory system) |
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Term
| benifit of nontunneled central venous catheter |
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Definition
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Term
| what are the disadvantages of a nontunneled cantral venous catheter? |
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Definition
Not flexible and may break
Dislodged more easily
Has the highest infection rate |
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Term
| Your read your patients chart and see that they are recieving chemotherapy on a regular basis what sort of central venous catheter would you expect them to have: tunneled or nontunneled? |
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Definition
| tunneled because chemotherapy is a long term therapy |
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Term
| Your patient has had a dacron cuff inserted a month ago and is on immunosuppressants. Do they require a dressing? |
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Definition
| Yes; they are on immunosuppresants which makes them immunocompromised (lowered immune system) |
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Term
| How often should the caps on the central venous catheters be changed? |
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Definition
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Term
Which one of these catheters only has to be flushed once every thirty days and only needs saline to flush?
Hickman
Broviac
Groshong |
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Definition
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Term
| What are some disadvantages to small gauge PICC lines? |
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Definition
| Fluids infuse slower, harder to draw blood back from, and may occuld easily. |
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Term
| Why do we check the length of the PICC line when we are in the patients room? |
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Definition
| To verify it against the chart and make sure that it has not moving out of the vein. |
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Term
| What is valsalva manuver and when is it used? |
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Definition
| bearing down as though one were about to deficate and it is used during the insertion of a CVC in the subclavian or jugular |
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Term
| If you don't get blood return through a lumen should you use it? |
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Definition
| no call the doc and get order for a clot buster |
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Term
| What is a turbulent flush and why do we use it? |
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Definition
| It is a stop and start means of flushing used to make sure that nothing accumulates on the end of the catheter |
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Term
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Definition
Saline Antibiotic Saline (this is method when line is continuously used)
Saline Antibiotic Saline Heprin (this is procedure when line is intermittenly used) |
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Term
| external tubing is changed ever ( ) hrs. |
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Definition
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Term
| Is dressing change for CVC a sterile or unsterile technique? |
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Definition
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Term
| How often should dressings be changed when transparent or gauze? |
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Definition
| transparent changed every seven days gauze every other day or when they become souled, wrinkeled (edges lifting from skin) or loose |
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Term
| What do you have to document in teh pt. chart? |
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Definition
| condition of site, type of dressing used, condition of the site and length of the catheter when appropriate |
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Term
| What do you do with the inital blood return from a catheter site when drawing blood for labs? |
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Definition
| discard it and flush with saline (10cc) and heprin (if indicated) afterwards |
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Term
| What would be discharge insturction for a patient going home with a CVC? |
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Definition
Proper handwashing and principles of sterile technique
Dressing change procedure and frequency
Flushing and cap change procedure and frequency
Observation of cath and insertion site |
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Term
| When should the patient call the doctor about their CVC? |
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Definition
Temp of 100.5F or greater
Chills, dyspnea, dizziness
Pain, redness, swelling, or drainage at site
Unresloved resistance, pain or fluid leaking when flussing
Hole or tear in cath
Excessive bleeding at site
Change in length of external cath
Swelling in neck, face, chest, or arm |
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Term
| General safety measures are? |
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Definition
No sharp objects near cath
Clamp cath when not in use
No pulling or tension on the cath
Discard syringes and needles in sharps container
Activity limitations
Use a stress loop |
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