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IV Quiz 2

Central Venous, Antineoplastics, Nutrition

What receives all blood flow from the upper half of the body? SVC
Choosing the approprite venous access device (VAD) for a pt is a _______ process involving the________, the _________ placing the device, and the pt's referring _________. collaborative, patient, practitioner, physician
What are most VAD's made of? silicone elastomers, thermoplastic urethane (T.P.U.), PVC
Catheters are available with what lumens? single, double, triple, quadruple
Port lumen
Distal port 16 guage; largest lumen, high volume or viscous fluid, colloids, meds, administration of blood or CVP monitoring.
Medial port 18 guage; TPN, meds if TPN not ordered
Proximal port 18 guage; blood sample, meds, blood component administration
Fourth port 18 guage; infusion of fluids or meds
CRBSI catheter-related bloodstream infection
Current research is pointing to the development of a ___________ during insertion and dwell on intravascular devices. biofilm
Bio-patch A tool to reduce the potential CRBSI is a dressing consisting of a synthetic and biopolymer composite foam impregnated with an antimicrobial.
Short term access devices nontunneled percutaneous catheter, implanted ports
How long are PICC lines able to stay in? 7 days to 12 months
Advantages of a PICC line reduced risk of CRBSI, reduced risk of infiltration and phlebitis, decreased risk of air embolism, cost effective, good for all ages, decreased pain.
Disadvantages of a PICC line bruising around the site, takes 45 min to 1 hr to complete procedure, potential for vein thrombosis, daily care
What are the preferred sites for PICC insertion? basilic vein, antecubital
How often should a PICC line dressing be changed? every 7 days or sooner if indicated
SASH Saline-Administration-Saline-Heparin - appropriate flushing method for a PICC line
When is a PICC line flushed? Whenever the line needs to be locked; after every blood draw, after intermittent med administration, after TPN
Push-Pause A pulsatile flushing that uses movements exerted on the plunger
What size syringe is used to maintain a psi of 7 when flushing? 10 mL
What is the catheter tip placement of a PICC line? Superior Vena Cava
What cells do antineoplastic drugs work primarily on? proliferating
How are antineoplastic agents classified? according to action on the cell cycle
What are the mainstay of today's cancer therapy? combination therapies
What are 3 short term complications for chemotherapy? alopecia, diarrhea, fatigue
What are 3 acute reactions of chemotherapy? anaphylaxis, nausa and vomiting, extravasation
Extravasation Infiltration of a vesicant drug
Routes of chemo administration peripheral; central; oral injection; intrathecal; IM; sub Q
IBW Ideal Body Weight
A loss of ______ of the usual weight or a current weight less than _______ IBW is considered a risk factor for nutrition related complications. 10%; 90%
Weight loss indicates an increased loss of _______ from the body cell mass in individuals who are malnourished. protein
What is the major protein synthesized by the liver? albumin
normal serum albuin level 3.5-5.0 g/dL
5 physical findings associated with nutrition deficiency Hair - brittle and dry Nails - brittle Skin - dry; poor skin turgor Eyes - dry Heart - size: large = tachycardia, small = decreased output
What is the most common complication of TPN therapy? Hyperglycemia
What nutrition includes the ingestion of foods orally and the nonvolitional delivery through a tube into the GI tract? Enteral
3 examples of patients who enteral nutrition would be contraindicated GI tract obstruction; paralytic illeus; diarrhea
PPN peripheral parenteral nutrition: 7-10 days, no surgery involved in placement, lower concentrations - metabolic complications are fewer; no weight gain; 10% glucose
TPN total parenteral nutrition: can stay in for weeks or months; complete nutrition - can increase weight; higher dextrose amounts - will need to taper them off of
Cancer treatment goals depend on situation Curative Palliative
Cycle specific designed to disrupt a specific biochemical process (effective only during specific phases of cell cycle)
Cycle non-specific their prolonged action is independent of the cell cycle (allows them to act on both reproducing and resting cells)
Combination Therapy Mainstay of cancer therapy
Antineoplastic selection depends on: Patient age Overall condition Tumor type Allergies or sensitivities Stage of the cancer
Antineoplastic Drug classifications Alkylating agents Antimetabolite agents Mitotic inhibitors (Vinca alkaloids) Cytotoxic antibodies Podophyllotoxin derivitives Pacific yew tree derivatives
biological response modifiers Enhance body’s ability to destroy cancer cells Enhance immune response to tumors by altering the way cells grow, mature and respond to cancer cells. Interferon, Interleukins
Routes of Administration Most commonly administered I.V. – using peripheral, or central veins Can be administered by oral, subcutaneous, intrathecal, I.M., and intra-arterial, or intra-cavitary routes
Chemo via other access devices Administration of chemotherapy via central lines, implanted ports, other routes, etc.
Common Side Effects of antineoplastics Venous fragility Alopecia Diarrhea Altered nutritional status d/t N&D Anorexia or taste alteration Fatigue
Acute Side Effects of antineoplastics Hypersensitivity or anaphylaxis Extravasation ( IV related) Stomatitis and mucositis Nausea and Vomiting Myelosupression (Neutropenia, Thrombocytopenia, Anemia Toxicities
Peripheral IV Catheters: Appropriate for most chemotherapy Should NOT be used for continuous vesicants due to risk of infiltration and extravasation. Definition of vesicant Extravasation is leakage of vesicant substance into tissues - irritating DO NOT use butterfly needles –
Choosing the correct vein Fully assess the hand and forearm for appropriate vein. Selecting a vein that’s soft and pliable Insert I.V. catheter proximal to recent puncture sites – prevents drug leaking Use antecubital fossa and back of hand as last resorts
Avoid with peripheral access: upper extremities with impaired venous circulation arms with functioning shunts, grafts, or fistulas for dialysis. using the arm on same side as previous mastectomy, if possible damage to superficial tendons and nerves,
Flushing After infusion complete, infuse at least 20mL of NS through the catheter before discontinuing I.V. line; prevents drug leakage into the tissue as the catheter is removed (called “drug tracking”) and minimizes future vein damage
True or False: We should wear protective clothing when handling body fluids from the patient for 48 hours after chemo treatment given. True
Compression and Compartment tightness in the patient’s arm – usually complain of numbness and tingling in the swollen area (due to large quantities of I.V. solutions entering the tissue indicates a nerve compression injury) NOTIFY DOCTOR IMMEDIATELY!!
Infiltration: swelling around I.V., cool to touch along with blanching and possible change in I.V. flow rate
The 3 C's related to inflitration Cut off (the solution) Counteract (effects of the drug) Contain (the affected area)
Extravasation S Initial signs may resemble those of infiltration – swelling, pain, and blanching Blood return is an inconclusive test Symptoms can progress to: blisters, skin, muscle, tissue and fat necrosis; and tissue sloughing.
What do you do for an etravasation emergency? STOP the infusion. Check facility policy to determine if I.V. cath removed or left in place to infuse corticosteroids or specific antidote. NOTIFY the doctor INSTILL the appropriate antidote according to facility policy
Post-Extravasation action Continue to visually monitor the site and document its appearance and the patient’s response.
What can the LPN do? Watch for infiltration Check for signs of hypersensitivity reaction Instruct patient to report burning, stinging, or pain at or near the site Observe for streaky redness along the vein or other skin changes
Signs and Symptoms of acute hypersensitivity: Dyspnea, Chest pain, increased heart rate, Dizziness, agitation and anxiety
Nutritional Assessment data collected History on nutritional habits Recent wt loss Ht & Wt, BMI or other Albumin (norm 3.5-5.0), Electrolytes, Urine Energy Requirements Physical Exam Hair (dry; brittle) Color of skin Eyes (dry and sunken in) Abdomen (distended; emaciated) Wounds (sl
Parenteral Nutrition Delivery of nutrient solutions directly into a vein, bypassing the intestinal tract IV Nutrition can be tailored to individual needs Can provide water, amino acids, carbohydrate, fat and micronutrients
Peripheral Parenteral Nutrition (PPN) Nutritional support via a peripheral vein Large Peripheral Vein Glucose limited to 10% If need more than 10%, can’t use peripheral vein Phlebitis common complication Used for short term 7-10 days Pt GI function return in 3-4 weeks Is not usually a
Total Parenteral Nutrition (TPN) Given via Central vein, nutrients greater conc. & smaller fluid Advantages Can provide total nutritional support for longer period of time Allows Bowel to rest Can gain weight w/ this Can use higher level of glucose % w/ this Disadvantages of Parent
What risks are associated with IV Nutrition? TPN requires surgical placement Peripheral veins—inflammation & infection TPN: Disease causing microorganisms introduced
Rule of Thumb 1: If clients can’t eat enough food to meet at least 50% of daily nutritional needs tube feedings should be considered.
Rule of Thumb 2: Parenteral nutrition can be discontinued when at least 70-75% of energy needs are being met by oral intake, tube feedings or both
Created by: MarieG