Empire Vein Specialists (EVS) is the premier vein and vascular center in Southern California. With three locations and more coming soon, EVS’s board-certified specialists have unparalleled experience treating varicose and spider veins. Our physicians are nationally recognized leaders of VenaSeal™, the latest minimally-invasive treatment for varicose veins, and have performed more VenaSeal™ procedures than any other practice in the U.S. Show
We provide a challenging and dynamic work environment and offer many opportunities for advancement, along with competitive compensation and incredible benefits, including health and dental coverage, CME reimbursement, and 401K with matching. Consider joining our fast-growing team to take your career to the next level! EVS is always looking for talented individuals to join our growing team, including:
Our Indeed job page lists current positions available now. Interested applicants for current and future available positions can also email your resume to or click here to upload your resume. Our recruiting team will review your application and contact you if there is interest in continuing to the next step in the hiring process. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of central venous access devices in order to:
Educating the Client on the Reason For and Care of a Venous Access DeviceThere are several types of venous access. Venous access can be done with a peripheral intravenous device and a central venous access device. Peripheral intravenous devices are used for short term intravenous therapy including fluids, electrolytes, medications and chemotherapy when the client has accessible and usable veins. Generally speaking peripheral intravenous catheters should be the shortest possible in terms of their length which is usually about 3 inches for the adult client and, as with other invasive therapies, peripheral intravenous devices should be left in place for the shortest possible period of time in order to prevent catheter related infections. Short peripheral catheters can typically stay in place for 72 hours; and a longer peripherally inserted midline catheters can remain in place for a longer period of time up to about 4 weeks in duration. These peripherally inserted midline catheters are longer than 3 inches and they range up to 8 inches in length and they are advanced into the brachial, basilic or cephalic veins. The intravenous catheter size depends on the patient's condition and their anticipated needs. For example, an 18 gauge catheter is used when the administration of a blood transfusion is anticipated; a larger gauge catheter, typically a 16 gauge catheter is used for a major trauma client with often unpredictable needs; and a smaller 22 or 24 gauge intravenous catheter is used when a client only needs intravenous fluids and medication with their peripheral venous catheter. A butterfly can be used for short term peripheral intravenous access of less than 24 hours and an Angiocatheter is used for peripheral intravenous therapy of more than 24 hours. Vein selection for a peripheral intravenous device should be based on a number of considerations. The best veins to select are the distal veins on the nondominant hand so that the client is able to fully use their dominant hand. The side of a client's mastectomy, paralysis and a dialysis access device are not used. Additionally, areas distal to a previous phlebitis or infiltration site should also not be used. The veins in the hand are not the veins of choice. Whenever possible, the upper extremities, rather than the legs, are used to prevent lower extremity phlebitis and emboli. The procedure for inserting a peripheral intravenous catheter is:
After the intravenous catheter is successful inserted, the intravenous line and the insertion site is monitored and maintained by the nurse. The intravenous line is monitored to insure that the line is patent and that the rate of flow is as ordered. The intravenous site is inspected for any signs of infiltration and infection. The dressing is changed and dated according to the particular healthcare facility's policy and procedure which is typically every 24 hours. Central venous catheters are inserted into the right atrium of the heart through the central venous superior vena cava. Central venous catheters can be advanced into the superior vena cava through a peripheral vein, as is the case with a peripherally inserted central venous catheter, or PICC, and also into the central venous system through the subclavian or jugular vein. Some of these catheters have multiple lumens, up to 3, and they vary in terms of how long they can remain in place. For example, a percutaneous, non tunneled subclavian catheter is used when immediate and short term treatments are anticipated, and other central venous catheters are tunneled and cuffed. For example, an implanted tunneled and cuffed central venous catheter can have a port that is subcutaneously placed and accessed with a non coring needle into the port's reservoir. Central venous catheters are a preferred method of venous access when the client is getting intravenous fluids or therapies in the home and also when the client:
Strict sterile technique is used for maintain and caring for a central venous catheter. Central venous catheter dressings are changed at least every forty eight hours unless it is an occlusive transparent dressing. These occlusive transparent dressings can be changed every 7 days unless they are wet, soiled or loosened. Some central venous catheters have a couple or several lumens. Each lumen must be flushed with a heparin solution on a daily basis in order to maintain patency. The injection cap on each lumen should be changed every 7 days or any time that the cap is leaking. Some of the complications associated with central venous catheters include infection, pneumothorax, hemothorax, thrombosis, emboli and an accidental cardiac perforation during the insertion procedure. Patient and family education about venous access devices begins with the informed consent procedure and it continues throughout the client's use of these devices. Some of the components of this education should include:
Accessing Venous Access Devices, Including Tunneled, Implanted and Central LinesAll venous access devices are accessed and maintained using sterile technique, therefore, nurses and not unlicensed assistive personnel insert, maintain and manage venous access devices. Additionally, some health care facilities limit the insertion, maintenance and care of all IVs to only registered nurses. Peripheral venous access devices are accessed by disinfecting all hubs prior to administering a piggy back or an Intravenous push bolus medication. For example, the procedure for an intravenous secondary piggy back line is as follows.
Providing Care for the Client with a Central Venous Access DeviceAlthough both peripheral and central venous access devices are managed and maintained with sterile technique, additional measures such as wearing sterile gloves and masks are needed with central venous lines because their risk for infection is much greater than that of a peripheral intravenous line. Both the nurse and the client wear a mask when a central venous access device is being accessed and cared for. A chlorhexidine solution is used to cleanse the insertion site and a chlorhexidine solution impregnated dressing is used to cover the site. The caps are changed and the flushing of the line is done before and after each access, such as when a medication or chemotherapeutic agent is administered. Central venous catheter dressings are changed at least every 48 hours unless it is an occlusive transparent dressing. These occlusive transparent dressings can be changed every 7 days unless they are wet, soiled or loosened. Some central venous catheters have a couple or several lumens. Each lumen must be flushed with a heparin solution on a daily basis in order to maintain patency. The injection cap on each lumen should be changed every 7 days and any time that the cap is leaking. Blood pressure readings and invasive procedures such as laboratory specimens are not done on the side of the central venous access device. RELATED CONTENT:
SEE – Pharmacological & Parenteral Therapies Practice Test Questions
Alene Burke, RN, MSN Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.  Latest posts by Alene Burke, RN, MSN (see all) Which of the following veins should a medical assistant recognize as the preferred vein for routine phlebotomy?Which of the following veins should a medical assistant recognize as the preferred vein for routine phlebotomy? The median cubital vein is a prominent vein located in the antecubital space, and it does not roll or move away from needles. The median cubital vein is the preferred vein due to accessibility.
Which of the following veins is the preferred vein for routine phlebotomy?Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Antecubital veins, right arm.
Which of the following tubes should a medical assistant select first?Which of the following tubes should a medical assistant select first when adhering to the proper order of draw? The yellow tube is the first tube in the order of draw. It is used for collecting sterile blood cultures.
How should an MA label a tube that contains a capillary sample?Included on the label should be at least the first and last name of the patient, the medical record or identification number, the date and time of collection, initials of the person collecting the specimen, and any other information required by the collecting facility.
|
Which of the following veins should a medical assistant recognize as the preferred vein?
Urheberrechte © © 2024 decemle Inc.
