Complication
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Assessment
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Prevention
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Intervention
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Pneumothorax
Hemothorax
Hydrothorax(pleural effusion)
(Most common immediately after insertion)
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- Chest x-ray to assess placement after insertion
- Dry cough & SOB & rapid weak pulse, cold and clammy, diminished or absent breath sounds
- Subcutaneous emphysema
- Chest pain
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- Careful insertion
- Stabilization of catheter
- Assessing placement by chest x-ray after insertion (especially when inserted via direct subclavian stick).
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- Administer oxygen, place patient in high Fowler's
- Aspirate air or fluid if possible
- Remove catheter
- Chest tubes
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Displacement or migration
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- Palpate exit site and tunnel for coiling
- Distended neck veins
- Edema around insertion site (often neck and shoulder)
- Unable to infuse and/or withdraw fluids
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- Secure catheter with tape to prevent "pull"
- Flush with 10ml syringe to prevent migration of catheter tip from subclavian to internal jugular vein
- Teach patient to refrain from vigorous sports depending on type of catheter
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- Stop infusions
- Reposition catheter
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Perforation or Cardiac Tamponode
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- Catheter has curved tip via x-ray
- Tachycardia, hypotension, muffled heart sounds, eventually no palpable pulses
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- Correct catheter tip placement so not lying in right ventricle
- Securing catheter to prevent migration into right ventricle
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- Removal
- Stop infusions
- Supportive care
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Air Emboli
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- Catheter open to air
- cracked
- not clamped when end open to air
- Shortness of breath, chest pain, tachycardia, confusion, mechanical noise over precordium, hypotension, hemoptysis
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Check catheter patency frequently
Only Groshong catheters can be open to air without risking air emboli - keep other catheters clamped or capped |
- If catheter cracked, clamp between exit site and crack (unless Groshong)
- Repair catheter
- If suspect air embolism:
- clamp catheter
- administer oxygen
- place patient on left side with head down
- Prepare for attempted aspiration of air
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Catheter Occlusion; thrombosis/fibrin sheath
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- Unable to infuse or withdraw from catheter (thrombosis)
- Able to infuse but unable to withdraw fluids (fibrin sheath)
- Pain or discomfort in arm, shoulder or neck
- Neck or shoulder edema
- Sutures not pinching off catheter
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- Routine flushing and maintenance of positive pressure
- Low dose anticoagulant therapy
- Flush between drugs (precipitates may occlude catheter)
- Avoid kinking catheter
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- Flush gently with normal saline using 10-20 ml syringe
- Reposition patient
- Cough and deep breath
- Raise arm
- If thrombus suspected infuse thrombolytic agent (strepto-kinase or urokinase) per agency protocol
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Infection |
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Exit Site
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- Redness, drainage, edema or tenderness at exit site
- WBCs at exit site may be elevated
- Assess risk factors (TPN infusion, immuno-suppressed, etc.)
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- Strict handwashing
- Aseptic technique
- Follow dressing change protocol - change loose or contaminated dressings
- Teach patient and family proper site care
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- Daily site care
- Antibiotics
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Tunnel
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- Redness, swelling, tenderness over tunnel
- WBC's may be elevated
- Assess risk factors
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- Proper site and catheter care
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- Blood culture
- Parenteral antibiotics (difficulty is delivering
- Removal of catheter
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Systemic
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- Increase or decrease in body temperature
- Chills, hypotension
- Leukocytosis may be present
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- Proper site and catheter care
- Prevention of thrombus formation (may be source of infection)
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- Parenteral antibiotics 10-14 days
- Blood cultures
- May have to remove catheter
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