Central Line Case study
Although the patient’s output seems to be adequate, everything else points towards dehydration. It also seems Like the patient has a fluid,’electrolyte Imbalance which may be putting the water in the wrong departments, or an infection (as reflected in apt.
Vital signs). So even though he is receiving IV fluids, it’s not reflecting on his physical assessment and labs. 2. ) What factors could be contributing to this problem? Part of the problem may be that most of the patient’s fluids are being received via IV (mill in 24 hours) and has only drunk mill POP in the past 24 hours.
Low GIG utility because of recent GIG surgery may have something to do with It, or a flee Imbalance, or an Infection could be a contributing issue.
Lastly fever and depositories can cause high amounts of insensible fluid loss. 3. ) Evaluate the patient’s electrolyte values and give a rationale for the answer. Urine specific gravity of 1. 035 is high; this means the patient’s urine is concentrated.
K+ of 3. 0 is low and is common with a patient with an ENG tube on suction. Apt. ‘s with ENG tubes loose potassium through suctioning. Sodium of 140 is normal but on the higher end which is indicative of dehydration.
Chloride of 92 is a little low which is interesting because the sodium is normal-high and usually chloride follows sodium.
Mage of 1. 4 is low maybe because of low calcium. 4. ) The physician Is planning to place a precancerous central line to infuse TAP. Which site is recommend and why? A precancerous central line is entered into the patient’s subclasses vein.
Because TAP solution is concentrated it is better to have C.V. access in the subclasses vein so the solution has less distance to travel to Its destination. This reduces the risk of the line clotting or damaging the vein. B. ) what are the nurse’s responsibilities for placement of the central line? The nurse is responsible for positioning the patient and should assess the patient throughout to see how well he is tolerating it.
If the patient is on a heart monitor, the nurse should monitor vital signs and heart rate as the catheter is being put in for any fluctuations. Afterward’s, the nurse should assess for complications or adverse reactions like pneumonia. Make the patient comfortable and listen to bilateral reheat sounds. Obtain a stats CRAY to verify correct placement.
I nee assessment Includes.
Date Ana time AT procedure, name AT provoker, sleet AT insertion, type of fluid infusing in each lumen, blood return from each lumen, chest X-ray ordered, completed and verified, and patient tolerance of procedure 5. ) The patient asks “Why can’t you Just use this IV in my hand? ” It is a GAG started in the OR four days ago. What is the nurse’s answer? A central line is placed to end in the superior even cave. This is a large vessel with a large amount of blood flow, so it an handle caustic fluids being infused into it.
A peripheral line is much smaller and has a lot less volume flowing through at any given time, so when certain fluids are infused, it can be very damaging to the vessel wall and can cause a lot of complications.
TAP contains a lot of packed particles, such as glucose and several minerals + electrolytes which can damage the smaller veins in the arms and hands. The similarity of TAP solution is too high for a small vein to handle. 6. ) The patient’s wife asks “Why don’t you put one of those tunneled catheters in? My sister had one.
Her doctor said it had a lower infection risk. ” What is the nurse’s response? Tunneled catheters have a lower risk of infection because they have a cuff that prevents microorganism migration into the catheter tract.
However tunneled lines are inserted in the OR and are an expensive and invasive procedure. They are for patients who will be on long term TAP therapy or dialysis; for patients with chronic issues. For your husband, the issue with nutrition is more acute and a long term tunneled catheter is not appropriate at this time.