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Lecture 6

NURS 342 Lecture Notes - Lecture 6: Hemodialysis, Polyethylene Terephthalate, Heparin


Department
Nursing
Course Code
NURS 342
Professor
Naysmith
Lecture
6

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Nurs 342: Week 1
Mat and Child p. 1112-1114
Venous Access Catheters and Devices
Using Intermittent Infusion Devices
Also called heparin locks
Devices that maintain open venous access for med admin. while allowing children to be free of IV tubing
Veins on the back of the hand are generally chosen as IV site
Scalp vein tubing is used and capped at the end with a specifically designed rubber stopper or commercial trap
Tubing filled with dilute solution of heparin or NS through rubber stopper and flushed again with solution q2-8h to keep it
patent
Medication added to site as needed
Tubing and stopper firmly secured to the wrist and armboard taped in place- protects site from trauma
Those receiving long term home and who only need IV medications- not additional fluids are good candidates
Can also be used for frequent blood sampling is required
Using Central Venous Access Catheters
Venous access for long term Iv therapy can be obtained using a catheter inserted into the vena cava just outside the right
atrium, the catheter exits the chest just under the clavicle
Types incl. broviac, hickman, groshong
Has Dacron cuff that adheres to SC tissue and helps seal the catheter in place and keep out infection
Used to admin bolus or continuous infusions of medications and fluids
Care- daily or weekly changes of dressings over exit sites, periodic irrigation with heparin or saline for patency
Advantages- discomfort from further skin punctures is avoided, disadvantage- can snag on something and be accidentally
pulled out
Unless waterproof dressing covering insertion site, children with CVCs recommended not to go swimming or take showers to
avoid infection
Vascular access ports
Infusion ports that can be implanted under the skin usually on the anterior chest under the clavicle for long erm fluid or med
admin via bolus or continuous med admin
A small catheter threads from the port internally into a central vein
After skin cleansing blood samples can be removed or meds can be injected by a puncture through the chest skin into the port
Does require a skin puncture- so does cause pain but may be more accepted bc it is not as visible
Allows more range of activities
To access these ports, use only the needle supplied by the manufacturer- because regular needle tends to core or remove a
small circle of the membrane over the port and destroy the integrity of the device
Children may also have a PICC line
oCan remain in place for up to 4 months without being changed
oInserted into arm vein- usually at antecubital sspace into the median, cephalic or basilica vein and advanced until tip
rests in SVC
oIf shorter catheter is used- tip will rest closer to the head of the clavicle- midline insertion
Drugs commonly administered by PICC lines are abx and analgesics
After med is administered, line is flushed with a solution such as NS
Newborns can have a catheter inserted into an umbilical vessel with fluid and meds being administered by that
route
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