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CLS Quiz 4
peripheral venous catheters - ANS: brief therapy, shorter catheters < 3 inches, not appropriate for vesicants (TPN, chemo, etc.) QUIZ: midlines - ANS: longer therapy, not a central catheter because the tip ends in the basilic/cephalic/brachial veins not used for hyperosmolar (TPN...thick) or vesicants QUIZ: CVADs (central lines) - ANS: longest term therapy, not routinely changed to reduce infection risk tip ends in the central venous circulation (superior vena cava near right atrium) access for IV fluids/meds/blood/TPN, allows for hemodynamic monitoring (CVP/fluid volume) and blood sampling
placement and verification guidelines to determine correct insertion (types: PICC, tunneled, nontunneled, port) QUIZ: PICC line - ANS: long term IV therapy, nurses can put them in can stay in 6 weeks to 6 months indications may include long term antibiotics, narcotic infusions, lots of IV fluids (hard to keep a peripheral site on), lots of lab draws, product that can be given through this: chemotherapy, vesicants, hyperosmolar solutions (TPN), blood components, vasopressors, anticoagulants may be single or multiple lumens, in home or hospital use, less risk of infection and pneumothorax (farther from lung site) cost effective QUIZ: Non-tunneled percutaneous central venous catheter - ANS: shorter dwell time 3- 10 days, usually emergency situations, internal jugular, subclavian, or femoral vein insertion, high risk for infection femoral distal tip is in the thoracic vena cava above the diaphragm
proximal tip implanted in subcutaneous pocket in upper chest wall require minimal care, access may cause patient discomfort (can insert lidocaine) require surgical removal, lowers risk for catheter related bloodstream infections QUIZ: PICC line maintenance - ANS: sterile dressing change 24 hours after insertion then every 3-7 days) masks may be required for flushing, drawing blood, changing dressing, etc. keep external catheter coiled under dressing change catheter caps every 3-7 days **refer to ppt QUIZ: patient instructions for discharge with a picc line - ANS: report gunk, redness, swelling, fever, etc. signs of infection dont mess with the line, how to change dressing, avoid strenuous activity, cover during showering or bathing, medical alert bracelet for long term use QUIZ: CLABSI - ANS: hospital aquired infection, s/s = fever, inflammation, purulent drainage at insertion site, sepsis common cause is staph draw blood cultures x2 (one from the line one from a stick on the other arm) if it is the catheter they may remove and culture the distal end QUIZ: CLABSI bundle - ANS: wash hands, sterile barrier precautions, CHG antisepsis, optimal catheter site selection (PICC line less risk), daily review of necessity and prompt removal when indicated 15-30 second hub scrub, change dressing when wet/soiled/dislodged, consider antiseptic containing dressings and port protectors/connectors clean gloves before accessing, and sterile technique with dressing changes, insertion, etc.
QUIZ: total parenteral nutrition (TPN) - ANS: nutrition given through a central venous access device patients not tolerating enteral nutrition, short bowel disorder patients with lipid or electrolyte deficiency, motility disorders, intractable diarrhea, impaired absorption, highly concentrated, provides calories, nitrogen balance, fluid replacement, vitamins, electrolytes, minerals, lipids, protein purposes: promotes tissue/wound healing, normal metabolic function, rests bowel to promote feeding, decreases activity in gallbladder pancreas and small intestine QUIZ: PPN (partial parenteral nutrition) - ANS: nutrition given parenterally through peripheral vein using short term IV access (low osmolality) less concentrated and less than 2 weeks duration QUIZ: what types of labs do you anticipate to monitor with TPN - ANS: BMP, CBC (liver enzymes), magnesium, phosphorus, total protein, albumin, glucose QUIZ: elements of TPN - ANS: hypertonic, proteins carbs, fats, tailored to individual patient needs, fats and dextrose to increase caloric value QUIZ: elements of PPN - ANS: isotonic, lower dextrose levels 10%, lower amino acids, refer to ppt. QUIZ: potential complications with TPN - ANS: hyper/hypoglycemia, acid base balances, hyperlipidemia, phlebitis, liver and gall bladder disease, thromboembolism, pneumothorax, infection, sepsis, refeeding syndrome (start feeding slowly) QUIZ: nursing care to prevent complications - ANS: same catheter lumen each time tubing is changed, use a pump, make changes in infusion rate gradually, wean patients gradually, discard solution within 24 hours of starting administration, vitals every 4 hours, blood glucose every 6 hours. strict aseptic technique with solution and tubing change, sterile technique to change dressings, infusion sets need inline filter that is changed every 24 hours compare daily weights to I&Os no more than 3 pounds no more than 1 kg/day labs daily QUIZ: how to explain risk vs. benefits of TPN - ANS: benefit: explain need for it bowel rest, needs nutrition that she cant get like normal it will help healing with improved nutrition, could die from malnutrition,
