Central Venous Catheters
Prior to using a central line, this must be done to confirm placement.
chest xray
True of false: If a patient's TPN gets behind in administering, the nurse can adjust the rate to catch up
False- TPN can NEVER be adjusted unless a physician writes an order for the rate to be adjusted
True or false: restraints are a first choice for infants and children with IVs
False: restraints are ALWAYS a last resort when all other options have been exhausted
This culture refuses blood transfusions
Jehovah's Witnesses- can receive autologous transfusions, hematopoietic stimulant medications, and fluids
What does a PTT measure? What is a therapeutic PTT?
A PTT measures time to allow for blood clotting. 60-100 (A therapeutic PTT means the blood clotting is properly delayed due to heparin)
Describe considerations associated with a peripherally inserted central catheter (PICC)
Can be placed by an RN or physician, used short term (6-8 weeks), common in home care, avoid blood pressure checks in this extremity
Peripheral Parenteral Nutrition is administered via _____ with a dextrose content not exceeding _____
1. Peripheral IV, 2. 10%
Symptoms of dehydration in infants
Sunken eye sockets, sunken fontanel, weight loss
This is the only fluid that can run alongside a blood product
What are the symptoms of an elevated PTT?
Delayed clotting-> risk of bleeding/bruising (bleeding gums, abnormal bruising patterns, tarry/dark stools)
Arrhythmias or heart tissue damage can occur if this CVC complication occurs
Malposition/migration
This is the volume administered in 24 hours when TPN is initiated
1000-2000 mL
Symptoms of dehydration in older adults
Thickened saliva, confusion (do not assess skin turgor)
Blood must be spiked within _____ of the time it arrived to the unit from the blood bank
30 minutes
True or false: heparin can be administered via gravity
False- must be delivered via infusion pump
These central line-associated tasks are prohibited in the LPN scope of practice
Access an implanted port, Access a CVC being used for hemodynamic measurement, Administer thrombolytic to declot a CVC (i.e., alteplase), Administer medcations via the umbilical access, Insert, remove, or repair a CVC
The frequency in which blood sugar is checked during a TPN infusion
Q 6-8h
Describe how a blood pressure can be used as a tourniquet
Can be used for older adults with fragile veins. Place 6 inches above insertion site. Inflate cuff to 10mmHg, 20mmHg if patient has a fluid deficit
Universal donor: O-, universal recipient: AB+
True or false: An LPN can adjust the rate of heparin if the provider changes the order
True- an LPN cannot titrate based on PTT, but can change an infusion rate if the ordered rate changes
Describe the process of flushing a CVC
Use a 10mL syringe, scrub the hub for 15 seconds and dry for 5 seconds, connect the syringe, unclamp the line, check blood return and flush using a push pause technique, clamp line, disconnect syringe, connect swabcap
Frequency in which TPN flow rate should be checked
Every 4 hours
List three anatomical/physical considerations of infants that contribute to an increased risk of dehydration
Infant kidneys absorb less fluid; Higher body surface area than body, likely to lose water through the skin; More subcutaneous fat: hold less water
Describe the initial interventions during a blood transfusion reaction
1. Stop the transfusion IMMEDIATELY 2. Begin an infusion of normal saline (with new tubing) at KVO rate 3.Remain with the patient and call for help 4.Notify the provider 5.Oxygen can be administered to patients with SOB 6. Send blood bag, label, and tubing to the blood bank for investigation
What is the LPN's role in chemotherapy administration? Where do chemotherapy supplies get disposed?
The LPN cannot administer chemotherapy, but can monitor a patient receiving chemotherapy and dispose of body fluids. All products contaminated with chemotherapy should be disposed in yellow bins.