Central Venous, Antineoplastics, Nutrition
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| What receives all blood flow from the upper half of the body? | SVC
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| 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
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| What are most VAD's made of? | silicone elastomers, thermoplastic urethane (T.P.U.), PVC
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| Catheters are available with what lumens? | single, double, triple, quadruple
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| Port | lumen
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| Distal port | 16 guage; largest lumen, high volume or viscous fluid, colloids, meds, administration of blood or CVP monitoring.
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| Medial port | 18 guage; TPN, meds if TPN not ordered
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| Proximal port | 18 guage; blood sample, meds, blood component administration
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| Fourth port | 18 guage; infusion of fluids or meds
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| CRBSI | catheter-related bloodstream infection
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| Current research is pointing to the development of a ___________ during insertion and dwell on intravascular devices. | biofilm
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| Bio-patch | A tool to reduce the potential CRBSI is a dressing consisting of a synthetic and biopolymer composite foam impregnated with an antimicrobial.
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| Short term access devices | nontunneled percutaneous catheter, implanted ports
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| How long are PICC lines able to stay in? | 7 days to 12 months
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| 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.
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| Disadvantages of a PICC line | bruising around the site, takes 45 min to 1 hr to complete procedure, potential for vein thrombosis, daily care
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| What are the preferred sites for PICC insertion? | basilic vein, antecubital
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| How often should a PICC line dressing be changed? | every 7 days or sooner if indicated
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| SASH | Saline-Administration-Saline-Heparin - appropriate flushing method for a PICC line
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| When is a PICC line flushed? | Whenever the line needs to be locked; after every blood draw, after intermittent med administration, after TPN
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| Push-Pause | A pulsatile flushing that uses movements exerted on the plunger
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| What size syringe is used to maintain a psi of 7 when flushing? | 10 mL
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| What is the catheter tip placement of a PICC line? | Superior Vena Cava
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| What cells do antineoplastic drugs work primarily on? | proliferating
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| How are antineoplastic agents classified? | according to action on the cell cycle
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| What are the mainstay of today's cancer therapy? | combination therapies
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| What are 3 short term complications for chemotherapy? | alopecia, diarrhea, fatigue
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| What are 3 acute reactions of chemotherapy? | anaphylaxis, nausa and vomiting, extravasation
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| Extravasation | Infiltration of a vesicant drug
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| Routes of chemo administration | peripheral; central; oral injection; intrathecal; IM; sub Q
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| IBW | Ideal Body Weight
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| 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%
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| Weight loss indicates an increased loss of _______ from the body cell mass in individuals who are malnourished. | protein
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| What is the major protein synthesized by the liver? | albumin
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| normal serum albuin level | 3.5-5.0 g/dL
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| 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
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| What is the most common complication of TPN therapy? | Hyperglycemia
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| What nutrition includes the ingestion of foods orally and the nonvolitional delivery through a tube into the GI tract? | Enteral
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| 3 examples of patients who enteral nutrition would be contraindicated | GI tract obstruction; paralytic illeus; diarrhea
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| PPN | peripheral parenteral nutrition: 7-10 days, no surgery involved in placement, lower concentrations - metabolic complications are fewer; no weight gain; 10% glucose
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| 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
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| Cancer treatment goals depend on situation | Curative Palliative
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| Cycle specific | designed to disrupt a specific biochemical process (effective only during specific phases of cell cycle)
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| Cycle non-specific | their prolonged action is independent of the cell cycle (allows them to act on both reproducing and resting cells)
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| Combination Therapy | Mainstay of cancer therapy
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| Antineoplastic selection depends on: | Patient age Overall condition Tumor type Allergies or sensitivities Stage of the cancer
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| Antineoplastic Drug classifications | Alkylating agents Antimetabolite agents Mitotic inhibitors (Vinca alkaloids) Cytotoxic antibodies Podophyllotoxin derivitives Pacific yew tree derivatives
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| 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
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| 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
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| Chemo via other access devices | Administration of chemotherapy via central lines, implanted ports, other routes, etc.
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| Common Side Effects of antineoplastics | Venous fragility Alopecia Diarrhea Altered nutritional status d/t N&D Anorexia or taste alteration Fatigue
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| Acute Side Effects of antineoplastics | Hypersensitivity or anaphylaxis Extravasation ( IV related) Stomatitis and mucositis Nausea and Vomiting Myelosupression (Neutropenia, Thrombocytopenia, Anemia Toxicities
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| 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 –
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| 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
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| 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,
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| 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
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| True or False: We should wear protective clothing when handling body fluids from the patient for 48 hours after chemo treatment given. | True
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| 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!!
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| Infiltration: | swelling around I.V., cool to touch along with blanching and possible change in I.V. flow rate
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| The 3 C's related to inflitration | Cut off (the solution) Counteract (effects of the drug) Contain (the affected area)
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| 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.
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| 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
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| Post-Extravasation action | Continue to visually monitor the site and document its appearance and the patient’s response.
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| 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
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| Signs and Symptoms of acute hypersensitivity: | Dyspnea, Chest pain, increased heart rate, Dizziness, agitation and anxiety
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| 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
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| 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
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| 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
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| 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
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| What risks are associated with IV Nutrition? | TPN requires surgical placement Peripheral veins—inflammation & infection TPN: Disease causing microorganisms introduced
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| 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.
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| 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
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