Advanced Skills - IV Therapy and Central Lines Review

Flashcards covering central line catheter types, complications, TPN, IV site assessments, IV push administration, catheter gauges, and pump safety.

Where is the tip of a Midline Catheter located, and how long can it stay in place?

The tip is located in the upper arm, and it stays in place for $1\text{--}4\text{ weeks}$.

What are the key specifications of a Peripherally Inserted Central Catheter (PICC)?

The tip is in the superior vena cava (SVC), it remains in place no longer than $6\text{ months}$, comes in single or double lumen, and can be removed by a nurse.

How is a non-tunneled percutaneous central catheter inserted, and what are its key features?

It is inserted through the jugular or subclavian vein in the neck with the patient in the Trendelenburg position. It is a triple lumen catheter and stays in place for $1\text{--}2\text{ weeks}$.

What features distinguish a tunneled catheter from other central line catheters?

It has a cuff where tissue grows around to keep it in place, is surgically placed, and must be removed by a surgeon.

What are the characteristics and nursing requirements for an implanted port?

It is placed in the upper chest through the subclavian or jugular vein with no visible catheter part, handles $2{,}000\text{ punctures}/2\text{ years}$, requires a HUBER needle, needs no dressing, and is used for oncology patients.

Why can't a nurse use a hemodialysis catheter immediately after placement, and how is a fallen dressing managed?

It cannot be used immediately because it is grafted and needs to heal. A dressing that falls off must be treated with a sterile dressing change.

What causes an immediate pneumothorax during central line insertion, what are its signs, and what is the exact order of nursing actions?

Cause: Catheter nicking something during insertion. Signs/Symptoms: Dyspnea, chest pain, abnormal lung sounds, low oxygen saturation. Order of nursing actions: 1) Raise head of bed (HOB), 2) Cough & deep breathe, 3) Apply oxygen, 4) Call the doctor (who will order a chest X-ray).

What causes an air embolism in a central line, how is the patient positioned, and what are the immediate steps?

Cause: Air in tube due to not priming or not clamping. Signs/Symptoms: Chest pain, low oxygen saturation. Interventions: Clamp catheter, replace with new posi flow, flush x2, reconnect, and aspirate out. Position the patient in Trendelenburg position to trap the air bubble in the apex of the right ventricle away from the pulmonary outflow tract.

What is the timeframe for acquiring a central line infection, and how is catheter rupture prevented?

Infection timeframe: Acquired in $48\text{--}36\text{ hours}$ (presents with redness, swelling, fever; prevented via sterile technique). Catheter rupture prevention: Use a $10\,\text{mL}$ syringe and flush slowly (presents with pain and gurgling).

How are catheter migration and occlusion managed?

Catheter migration (tip not in right spot): Assess placement. Occlusion (unable to aspirate or flush): Change position, cough, or administer a clot buster.

What are the '4 Cs' of rationale for preventing central line complications?

1) Clean, 2) Cover up, 3) Change, 4) Conscientious.

Who requires Total Parenteral Nutrition (TPN), what is its duration, and what is its most essential component?

Indicated for patients with malnutrition, critical illness, and gastrointestinal problems. It is not long term (a couple of weeks). Essential component: Amino acids (proteins & carbs), along with electrolytes, vitamins, trace elements, and potentially insulin.

What assessments and supplies are required when administering TPN?

Assessments: Lung sounds, weight, oxygen saturation, daily labs (hypo/hyper), ACHS glucose monitoring, and BUN/CREAT & AST/ALT. Supplies: Tubing changes, solution changes, infusion pump, and filter.

What are the administration rules and contraindications for IV lipids?

Lipids are the only thing that can run with TPN, must run on their own channel (do not run piggyback), and are contraindicated in patients with an egg allergy or severe hepatic disease.

What is the purpose of a positive fluid displacement device, and when must it be changed?

It keeps fluid moving forward. It must be changed on central lines with every dressing change (prime before connecting) and changed with every blood draw due to increased infection risk. Clamp after every use following the order: Flush - remove syringe - clamp.

What are the findings for a normal versus abnormal IV site assessment?

Normal: Clean, dry, and intact. Abnormal: Pain, redness/erythema, edema, coolness, blanching, leaking, bruising, streak formation, palpable venous cord, or purulent drainage.

How do infiltration, phlebitis, and extravasation differ?

Infiltration: Leakage of NON-vesicant fluid into subcutaneous tissue (blanching, edema, coolness, pain). Phlebitis: Irritation/inflammation of vein (erythema, warmth, streak formation, palpable venous cord, purulent drainage). Extravasation: Leakage of VESICANT fluid (e.g., dopamine, dobutamine, chemo) causing serious tissue injury (blistering, tissue necrosis/ulceration, taut skin).

How long can a peripheral IV stay in place, and how should IV access ports be cleaned?

Replace every $72\text{--}96\text{ hours}$ or until causing issues. Clean access ports aseptically by scrubbing with friction/twisting for $10\text{--}15\text{ seconds}$ rather than simply wiping.

What are the benefits and risks of IV Push (IVP) medication administration?

Benefits: Rapid onset, easily controlled dose, titratable, short prep time, convenient for multiple meds or children/elderly. Risks: Higher risk of adverse reactions, minimal time to stop allergic reaction if given too fast, increased risk of phlebitis, contamination, and air embolism.

What are the 9 Rules of IV Medication Administration?

1) Right patient (2 identifiers), 2) Right drug, 3) Right route, 4) Right dose, 5) Right time, 6) Right dilution/fluid compatibility, 7) Right flow rate, 8) Right monitoring, 9) Right documentation.

What is the correct sequence for administering an IV push medication through an existing compatible IV line?

1) Select port closest to client, 2) Clean port with alcohol using friction and twisting ($10\text{--}15\text{ seconds}$), 3) Pinch line (use push-pause technique throughout), 4) Flush with $5\text{--}10\,\text{mL}$ NS, 5) Clean, 6) Give medication, 7) Clean, 8) Flush at same rate as medication given, 9) Clean or cap as necessary.

What is the correct sequence for IV push administration if the medication is incompatible with the primary IV fluid?

1) Stop IV fluid, 2) Clamp line, 3) Pinch line (push-pause technique), 4) Clean, 5) Flush with $5\text{--}10\,\text{mL}$ NS, 6) Clean, 7) Give medication, 8) Clean, 9) Flush again with NS, 10) Clean, 11) Unclamp and restart IV fluid. (Use a second IV site if primary fluid cannot be stopped).

What does the SASH mnemonic stand for in saline lock administration?

S = Saline flush, A = Administer medication, S = Saline flush, H = Heparin (as needed and according to policy). Aspirate for blood return during the first flush.

What does the CATS PRRR mnemonic stand for in safe IV medication administration?

C = Compatibilities, A = Allergies, T = Tubing correct, S = Site checked, P = Pump safety checked, R = Right rate, R = Release clamps, R = Return and reassess the patient.

When must a medication label be checked during administration?

1) When removing it from the drawer, 2) Before opening it, 3) Before discarding it prior to administering the medication.

What guidelines govern IV site selection?

Assess both arms (forearm/hand); consider comfort/mobility; avoid affected side in post-mastectomy/AV fistulas (use unaffected side with most lymph nodes); start at most distal vein; non-dominant arm; avoid thin/scarred veins or veins crossing joints; avoid antecubital (AC) veins unless emergency or imaging contrast ($18\,\text{g}$).

What are the primary clinical indications for 16-18g, 20g, 22g, and 24-26g IV catheter gauges?

16–18g: Trauma, surgery, high fluid volume (painful, needs large vein). 20g: Most used (blood and most medications). 22g: Most medications, easy to insert, appropriate for small/thin fragile veins and low rates. 24–26g: Infants, children, older adults, fragile veins, low rates.

How is skin prepared for an IV start, and what is the maximum number of insertion attempts permitted?

Clean site by scrubbing with chlorhexidine for $30\text{ seconds}$ and allow to dry for at least $30\text{ seconds}$ (do not touch site after cleaning). Maximum allowed insertion attempts: $2\text{ attempts}$.

What special considerations apply to pediatric IV starts and infusions?

Use scalp or foot veins in infants; 26–24g for neonates, 24–22g for children; use small solution volumes ($250\text{--}500\,\text{mL}$); use smart pumps with guardrails; transillumination may be used; NEVER use gravity.

What special techniques should be used when starting an IV on an elderly patient?

Use smaller gauge catheters; tourniquet is optional (use minimal/no tourniquet pressure); stabilize rolling veins with traction; use lower insertion angle ($5\text{--}15^\top$); use paper tape; check site frequently for infiltration because pain may not be reported.

What do upward and downward occlusion alarms indicate on an Alaris pump?

Upward occlusion: Occlusion above the channel (check IV tubing). Downward occlusion: Occlusion below the channel (check IV site / patient bent arm).

How do you correct an overfilled drip chamber and blood backing up in IV tubing?

Overfilled drip chamber: Close regulator clamp, turn fluid container upside down, squeeze chamber until half full. Blood backing up: Check connections, ensure fluid is above heart level, check if fluid ran out, and check infusion rate.

What is speed shock, what are its symptoms, and how is it prevented?

Definition: A sudden adverse physiologic reaction to an IV medication administered too quickly. Symptoms: Flushed face, headache, chest tightness, irregular pulse, loss of consciousness, cardiac arrest. Prevention: Follow correct administration rate and maintain proper monitoring.