NR 33 CVAD scenario page # 1

You are caring for the following clients with CVADS:

Bed / Client report
1 / 79 y/o male PNU newly diagnosed COPD who has no available peripheral IV sites requires insertion of a TLC at the bedside
2 / 52 y/o fem s/p bowel resection, colon CA post-op insertion of a life port requires initiation of IV therapy through the port.
3 / 72 y/o fem CVA day 2 PMH HTN,CAD, DM, A fib with a triple lumen catheter to the right internal jugular (RIJ) with an occlusive dressing dated for 7 days ago and an order to flushed unused ports as per hospital protocol whose IV infusing to the white port via and electronic pump that is alarming “occlusion”.

1.  Which client should you assess first based on the information provided?

2.  You decide to assess the client in Bed #3. What do you need to address first with this client and what can be deferred?

3.  How would you troubleshoot the pump alarm?

4.  Review the procedures to restore patency to CVADS.

Managing Occlusions: See lab webpage for accessing the links below or right click from microsoft word document
Central Venous Access Device (CVAD): Restoring Patency to an Occluded Catheter (Restricted)
Central Venous Access Device (CVAD): Restoring Patency for Withdrawal Occlusions
What data does the nurse need to collect?
How is the catheter assessment performed? What equipment is needed? What are the steps?
What complications can occur with forceful flushing/aspiration?

5.  For the first assigned patient, see the section for catheter insertion in the TLC guidelines on the lab webpage for the nursing responsibilities. Be prepared to answer the following questions:

a.  What type of consent is required?

b.  Which actions would enhance venous return and increase intrathoracic pressure?

c.  How is catheter placement confirmed?

d.  What test is performed immediately after insertion?

e.  What would you document after insertion and placement verification?

6.  You decide to assess the client in Bed 2. Review the procedures below. Which procedure would apply?

Implanted Ports:
Central Venous Access Device - Subcutaneous Implanted Port (Port-A-Cath®, Infus-A-Port®, Mediport®: Accessing and General Information
Central Venous Access Device - Subcutaneous Implanted Port (Port-A-Cath®, Infus-A-Port®, Medi-port®) - Deaccessing

What data does the nurse need to collect before initiating the infusion? How is the implanted port accessing performed? What equipment is needed? What are the steps?

What complications can occur with forceful flushing/aspiration?

7.  You are preparing to provide routine care that was deferred earlier to attend to higher priority concerns for bed#3. To identify the appropriate care for the flushing unused ports and dressing change responsibilities, select from the policies and procedures below.

What equipment is needed? What are the steps?

______

Routine care:
Central Venous Access Device (CVAD): Dressing Change
Central Venous Access Device (CVAD): Medication Administration
Central Venous Access Device (CVAD): Removal
Central Venous Access Device (CVAD): Routine Flush/Flush Volumes and Blood Drawing/Discard Volumes
Central Venous Access Device (CVAD): Blood Drawing
Central Venous Access Device (CVAD): Changing Needleless Cap
Central Venous Access Device (CVAD): Connecting/Disconnecting Intravenous Fluids