Spent 24 hours over the past two weeks working with nurses on how to prevent complications from Vascular Access Devices at our annual skills fair. The most important thing to do with every patient no matter what device you are placing is to know the therapy ordered. We need to know the ph of the therapy, length of therapy and the vasculature of the patient. Put a tourniquet on and get a good visual of the veins, how large are they? Are they straight? We need to place the smallest gauge angio that can accommodate the therapy. When we place PIV’s in a vein that is too small for the gauge of the catheter, it puts the patient at risk for a mechanical phlebitis. If our central lines, PICC’s, Ports, CVC’s do not have a blood return we should be asking ourselves why not? We need to do some troubleshooting. Catheters tips in the SVC should always provide a blood return. We need to save these lines for our patients. I had heard of a patient at home who was receiving PPN over 12 hours during the night. He was complaining of severe headaches for many weeks and was physically feeling fatigued. A nurse checked his PICC line and noticed no blood return. Fluroscoy was ordered and it was noted that the tip of his PICC was in his internal jugular vein. This patient suffered needlessly for several weeks. Nurses need to be the the advocates for our patients and be knowledgeable in preventing and treating complications from vascular access devices.
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