Transcript Chapter_041x

Central Venous
Intravenous
Catheters
The catheter tip lies in the Central Circulatory System
close to the right atrium.
Objectives
Central venous access

Identify the types of central lines/implanted ports.

Identify nursing responsibilities in the care of central
venous catheters.

Identify major complications of central venous
catheters

List the most common types of intravenous therapies
infused via central venous access devices.

List the equipment necessary to access an implanted
port and central lines.
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Objectives
Blood Transfusion

Identify various types of blood and blood products and
reasons for their administration to a patient.

Identify the risks of blood transfusion

Discuss procedures to reduce the risk of blood
transfusion reactions

Discuss nursing intervention for the patient with a
transfusion reaction

Identify the essential steps necessary in the safe
administration of blood and blood products to a patient.
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Central lines

Central lines empty into a central vein which applies to
the location of the catheter tip not to the insertion site.

Peripherally inserted central catheters (PICC lines)enter
a peripherally arm vein and extend through the venous
system to the superior vena cava where they terminate.

Other central lines enter a central vein such as the
subclavian or jugular vein or tunneled through
subcutenous tissue.
Central line Catheters

Central lines effective for large volumes of
fluids,parenteral nutrition, and medications or fluids
that irritate veins.

Proper care is critical to prevent catheter-related
bloodstream infections( CRBSI)

Nursing responsibilities for central lines include careful
monitoring, flushing to keep the line patent, and site
care and dressing changes.
Central lines Catheters
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Central Catheters
A Hickman line is a central
venous catheter most often
used for the administration of
chemotherapy or other
medications, as well as for the
withdrawal of blood for analysis.
Some types are used mainly for
the purpose of apheresis or
dialysis.
Groshung Catheter
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Broviac catheter
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Port a Cath
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Three- lumen catheter
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3 lumen catheter

Distal port for blood sampling –this is the largest
16gauge

Medial port for parenteral and nutrition- 18g

Proximal port for medication administration- 18g
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Objectives for administering
blood transfusions
Increase circulating blood volume after surgery, trauma,
or hemorrhage
Increase the number of RBC and maintaining
hemoglobin levels in patients with severe anemia
Proving selected cellular components as replacement
therapy ( clotting factors, platelets,albumin
Avoid incompatibility blood transfusion must be
matched to each patient.
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Blood Types Chart/blood
group

There are eight different common blood types
determined by the presence or absence of certain
antigens.

Safe blood transfusions depends on careful blood typing
and cross-matching.
The Universal red cell donor has type O negative blood
type.

The universal plasma donor has type AB blood type.
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The ABO blood group System

Group A- has only A antigen on red cells(B antibody in
the plasma)

Group B- has only B antigen on red cells (A antibody in
the plasma)

Group AB- has both A and B antigens on red cells (but
neither A nor B antibody in the plasma)

Group O- has neither A nor B antigens on red cells( but
both A and B antibody are in the plasma)
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Blood types

Blood types must be matched for a safe transfusion.

Group O can donate red blood cells to anybody. It’s the
universal donor.

Group A can donate red blood cells to A’s and AB’s

Group B can donate red blood cells to B’s and AB’s.

Group AB can donate to other AB’s, but can receive
from all others.
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Antigens

Third antigen called the Rh factor, which can be present
(+)or absent(-)

Rh negative blood is given to Rh negative patients, and
Rh positive blood or Rh negative blood may be given to
Rh positive patients.

The universal red blood cell donor has type O negative
blood type.

The universal plasma donor has Type AB blood type.
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Antibody

An Antibody is a protein that the immune system
produces to neutralize a threat to the body
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Blood type and the
population

Studies-
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Hispanic people , have a high number of O’s
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Donor and recipient are from the same ethnic
background the chance of a reaction can be reduced.

Blood types is inherited. Whether your blood group is
type A,B, AB, or O is based on the blood types of your
mother and father.
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Blood Transfusion

Blood component therapy = IV administration of whole blood or blood
component- (packed red blood cells, platelets, or plasma)

Blood groups and types:

Packed red blood cells -Donor O

Type O blood is the universal donor for RBC

Fresh –frozen plasma- Donor –O Recipient-O

Type AB Blood is the universal donor for plasma

Platelets- Donor O Recipient O,A,B, AB

Autologous transfusion-collection and reinfusion of patient’s own
blood.

Transfusing blood- requires an order

Patient safety is a nursing priority.
Recipient- O,A,B, AB
Tubing for Transfusions
Unit of packed cells
Normal Saline
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Blood transfusion Reaction
Allergic reaction –hives, pruritus, facial flushing, severe
shortness of breath and bronchospasm
Febrile reaction- chills, fever, headaches, flashing, nausea
and vomiting and increase anxiety.
Hemolytic transfusion reaction:

Low back pain, hypotension, burning sensation along
the vien, fever 105 or higher, chest pain, labored
respirations, headache, immediate onset.
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Transfusion Reactions
Nursing Implications

Stop the transfusion

Change IV tubing and start a normal saline drip

Treat shock if present –O2, fluids, epinephrine as ordered.

Immediately notify health care provider.

Remain with patient and take vital signs every 5 minutes.

Prepare to administer emergency drugs

Antihistamines, vasopressors, fluids, and cortisteroids

Prepare to perform CPR

Save blood tubing, bag, attached labels, and transfusion
record for return to the blood bank.
Continue
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Acute adverse effects that do not involve an immune
response to the blood components also can occur during
transfusion.

Circulatory overload when patient receives massive
transfusions.

Older adults at risk and those with circulatory overload.

Blood transfusion contaminated with bacteria,
especially gram negative bacteria, can cause sepsis.

Disease transmitted by blood from infected donors

Hepatitis B and C , Human immunodeficiency virus
infection, and acquired immunodeficiency syndrome.
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Legal issues –vascular access

The decision of the kind of vascular access proposed to
patients

Is the choice tunneled or nontunneled

The risk of complications

A complete informative easy to understand consent
form.

The use of ultrasound guidance for cannulation

The use of floroscopy for checking the position of the
metal guidewire during the procedure as well as the
CVC tip before end of the procedure.

Inappropriate catheter care.
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Legal issues- blood
transfusion

Obtain the patient’s informed consent before
administering blood products.

Include explaining to the patient the benefits and risks
of receiving and not receiving the blood product.
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Thank you
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