Central Venous Access

Cover the device and the needle with a sterile transparent dressing.

A nurse caring for a patient who has gastric cancer is initiating an infusion of parenteral nutrition via the patient's implanted port. Which of the following is an appropriate action for the nurse to take?

Clamping the extension tubing while removing a syringe from the injection cap.

A nurse is caring for a patient who has a central venous access device in place. Which of the following routine measures should the nurse use specifically to prevent lumen occlusion?

On his left side in Trendelenburg position.

A nurse is caring for a patient who has a central venous catheter and suddenly develops dyspnea, tachycardia, and dizziness. The nurse suspects air embolism and clamps the catheter immediately. The nurse should reposition the patient in which of the following positions?

Catheter rupture.

A nurse is caring for a patient who has a central venous catheter. When flushing the catheter, the nurse uses a 10-mL syringe to prevent which of the following complications associated with central vascular access devices?

Uses non-heparinized saline solution for the flush.

A nurse is preparing to flush a patent's peripherally inserted central catheter (PICC). Because the patient's catheter has a valved tip, the nurse:

Turn off the distal infusions for 1-5 minutes before obtaining the blood sample.

A nurse is preparing to obtain a blood sample from a patient who has a triple-lumen central catheter in place for multiple therapies. Which of the following is an appropriate action for the nurse to take?

B) "To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves."

A patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. The patient states, "at least the doctor won't be wearing surgical garb when he puts the IV in." How will the nurse answer the patient? A) "You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire." B) "To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves." C) "It depends on the doctors preference." D) "Most doctors only wear sterile gloves, not a cap, mask, or sterile gown."

A non tunneled percutaneous central catheter

A patient who has sustained trauma from a motor-vehicle crash is transported to an emergency department. The provider determines the need for immediate central venous access for fluid and blood replacement and prophylactic antibiotic therapy. The appropriate central venous access device for this patient is:

B) Assess the patient for other indications of infection and notify the physician

A)Your patient has a central line which has been in place for 6 days. When performing site care you notice the insertion site is inflamed with a small amount of drainage. Which of the following is the most appropriate action by the nurse? A) Carefully document your observations in the chart and notify the Infection Control nurse B) Assess the patient for other indications of infection and notify the physician C) Discontinue the catheter and culture the tip and insertion site D) No action indicated except documentation. Inflammation and drainage are to be expected due to mechanical irritation.

An implanted port.

An older adult patient who adheres to a regular cardiovascular rehabilitation schedule that includes water aerobics and swimming requires long-term central venous access. Which of the following central venous access devices is the best choice for allowing him to continue his aquatic program?

D) Allergy

Which of the following is not a complication of CVCs? A) Pneumothorax B) Infection C) Carotid puncture D) Allergy

A) clavicular head of sternocleidomastoid B) clavicle C) Sternal head of sternocleidomastoid

RIJ Landmarks: the anterior triangle consists of what landmarks? A) clavicular head of sternocleidomastoid B) clavicle C) Sternal head of sternocleidomastoid D) Anterior border trapezius

A) clavicle B) posterior border of sternocleidomastoid D) Anterior border trapezius

RIJ Landmarks: the posterior triangle consists of what landmarks? A) clavicle B) posterior border of sternocleidomastoid C) Sternal head of sternocleidomastoid D) Anterior border trapezius

D) Allow different medication or solutions to be administered simultaneously

Some central venous access devices (CVAD) have more than one lumen. These multi-lumen catheters: A) Have an increased risk of infiltration B) Only work a short while because the small lumens typically clot off C) Are beneficial to patient care but are prohibitively expensive D) Allow different medication or solutions to be administered simultaneously

B) Tunneled catheter

The following characteristics best describe what type of central venous access device? -i.e. Hickman, Broviac, Groshong -decreased potential for infection from skin exit site -weekly site care -flush with heparin EXCEPT Groshong -Surgically inserted ~5" under skin before entering vein A) Peripherally inserted central catheter B) Tunneled catheter C) Non-tunneled catheter D) Port-a-cath

Port-a-cath

The following characteristics best describe what type of central venous access device? -single or double lumen -no dressing change unless accessed -need to use HUBER needle to access it -When accessed change needle & dressing q7 days -flush with heparin monthly when not accessed

A) Do not clamp the catheter after flushing

The nurse is developing a plan of care for a patient with a Groshong catheter. The plan of care should include A) Do not clamp the catheter after flushing B) Flush with 5 ml saline followed by 30 unites heparin every 8 hours C) Apply Betadine ointment to insertion site with each dressing change D) All of the above

B) Momentarily stop infusates containing glucose or electrolytes according to protocol.

The nurse is preparing to draw a blood specimen for laboratory analysis from a multilumen central venous catheter. Which of the following is the first step in the process? A) Clean the port of the lumen with alcohol and allow to dry. B) Momentarily stop infusates containing glucose or electrolytes according to protocol. C) Flush the lumen with normal saline to assure accurate placement. D) Use a pulsating motion when aspirating and removing the blood specimen.

D) "Heparin may be instilled into the lumen of the catheter to decrease the risk of clotting."

The nurse is providing patient education related to a patient's central venous access device. Which of the following statements will the nurse make to the patient? A) "These devices are essentially risk free." B) "These devices seldom work for more than a week." C) "The dressing should only be changed by your physician." D) "Heparin may be instilled into the lumen of the catheter to decrease the risk of clotting."

D) Having patient turn their head or raise their arm

The nurse suspects a nonthrombotic occlusion of a central venous catheter. What intervention should the nurse complete first? A) Stopping the IV and calling the MD B) Increasing the IV rate for 5 minutes C) Requesting an order for a chest x-ray D) Having patient turn their head or raise their arm

True

True or False: Central venous access devices (CVAD) can be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea because concentrated hyperalimentation can be administered through the CVAD?

Decreases the risk of infection

What is the purpose of "tunneling" when the surgeon inserts a Hickman central catheter device?

10 ml

When irrigating a central venous catheter, the barrel capacity of the syringe should be a minimum of?

B) Use of the arms is not restricted

Which would be a reason why central venous access devices are beneficial in pediatric therapy? A) They don't frighten children B) Use of the arms is not restricted C) They cannot be dislodged D) They are not associated with risk of infection

Pneumothorax

chest pain, dyspnea, apprehension, cyanosis; complication that most often occurs during placement of the central venous line

Alterplase

drug used for a thrombotic occlusion of a central venous access device

Malpositioned catheter

ear or neck pain palpitations, inability to irrigate

Local infection

fever, chills, shock, malaise, leukocytosis; red, swollen, warm, tender site

Air embolism

loud churning heard over pericardium on auscultation, chest pain, and hypoxia; complication that could occur if the Luer lock and catheter become disconnected