IVs and CVADS

[NUNS2016]

Hi again! Back at it for the third year, this one is the beginning of the true test, I believe. We go to medsurg 1 clinicals next week. Very excited!

Anyway, I'm here today to ask about IVs. We're just learning about them in a medsurg fashion...and I think I may be over thinking some things. So these questions are pretty basic, but feel free to elaborate as much info as you want. I'm looking for info anywhere I can get it!

So, the chapter we're in has a section about CVADs, which I understand to be access points to the central vascular system via a log tube inserted from a point on either your periphery or neck site, which extends either halfway (midline) up your central line, or all the way to the SVC. Although, my teacher informs that she has rarely seen a midline (other than someone who didn't bring enough tubing, and only made it half way, when it was supposed to be to the SVC). So, I feel okay about that...but what about just the little IVs that we get or give in the hand or AC (antecubital)? Are those just not in the umbrella of CVAD? Are they technically called something else?

When I figure this out, I know I'm going to feel silly, but I can't help but ask. She stated that you don't take blood from a peripherally inserted catheter, and I know that when I donate blood, there isn't a tube going from my AC to my SVC...so I guess the CVAD includes only IVs that go into or halfway to the SVC?

When someone is admitted or treated in the hospital, they usually get an IV, but its not a CVAD, right?? It's just a little guy in the hand or AC (or somewhere else)...yes? So, is this portion ONLY about the ones that go into your SVC?

I'm sorry, this probably became crazy about 1/3 of the way thru...but I'm really trying to figure this out on my own. My problem is, this chapter only talks about CVAD, and there doesn't seem to be another chapter with IV info...so....are these all of them?

Ugh, sorry

Thank you all!! If this doesn't make any sense, just give me your overview on IVs and maybe it'll be answered in there.

Thanks,

Sophie

[Bedside_Life RN]

When the patient has a Power PICC (saline lock, not Hep lock) with continuous maintenance fluids, I stop the infusion 10-15 minutes prior to flushing and drawing back.... Is this not best practice.....? Thank you.

[Bedside_Life RN]

Nuns2016, with so many responses I would suggest you call the BON in your state. They will be able to provide you with the most recent scope of practice. When posting questions please take the time to read the "about" section of each person providing insight on how to practice and not only ensure that they are a licensed nurse (especially in your case) but that they are also providing you with the best Evidence based practice. If you are unsure, ask them where the information came from to support their opinion or position.

Remember, a facility can limit your scope of practice in relationship to the BON, but they can never, ever, expand it.

The very best of luck to you. What a great post!

[IVRUS, BSN, RN]

No.. Not best practice. Stop for one minute. Then, draw labs after flush/discard.

[KelRN215, BSN, RN]

When the patient has a Power PICC (saline lock, not Hep lock) with continuous maintenance fluids, I stop the infusion 10-15 minutes prior to flushing and drawing back.... Is this not best practice.....? Thank you.

Why would you need to stop for 10-15 minutes prior to obtaining your sample? Blood is flowing through the SVC rapidly, there's no need to wait 10-15 minutes.

[Bedside_Life RN]

Thank you for clearing this up..... the 10-15 minute wait time comes from the priority of needs of the other six patients requiring care. I was not aware of this being a problem.

This is the perfect example of how Nursing is a practice....all healthcare providers can learn from one another, so I appreciate this feedback.

For the sake of the person posting, IVRUS...will you provide the source for this best practice.

Nun2016, this shows that we are all a team; providing holistic and safe care is our goal.

This has been a great discussion and hopefully reliable and constructive.

Be confident in your abilities but respect your limitations..... you can always learn from others. But always have a reputable source to support the way you practice.

I am sure that IVRUS will be able to provide the readers with this pertinent information.

[IVRUS, BSN, RN]

The flow of blood into the SVC from the brachiocephalic vein is dependant on diameter, length, and resistance within the vessel. The rate of blood flow into the SVC is greater than 10x the flow in the upper arm. But it does vary. Looking at this paper, Superior vena cava flow and... [Arch Dis Child Fetal Neonatal Ed. 2012] - PubMed - NCBI you'll see how normal flow is approx. 55-111 ml/kg/min for neonates.

Rapid flow rates will quickly dilute solutions/medications and therefore 10-15minute hold on the infusate is too long.