Quiz: Accessing an Implanted Port & Quiz: Changing the Dressing and Flushing CVADs

A nurse is administering blood products to a client via an implanted port central venous access device (CVAD). What technique should the nurse use to locate the site of the port? A. palpation B. Percussion C. Auscultation D. Observation

A. palpation

The nurse is caring for a client who is receiving total parenteral nutrition. While changing the dressing of the client's central venous access device (CVAD), the nurse cleanses the site with chlorhexidine. Which action would the nurse perform next? A. Apply the transparent site dressing or securement/stabilization device over the insertion site. B. Apply skin protectant to the same area, avoiding direct application to the insertion site. C. Wipe or blot the area with a sterile gauze pad and allow it to dry completely. D. Apply skin protectant to the same area, applying it directly on insertion site.

B. Apply skin protectant to the same area, avoiding direct application to the insertion site. After cleansing the site with chlorhexidine, the nurse would allow the site to dry completely without wiping or blotting the area. The nurse would then apply skin protectant to the same area, while avoiding direct application to the insertion site, and allow it to dry. Skin protectant improves adhesion of the dressing and protects the skin from damage and irritation when the dressing is removed. After applying skin protectant, the transparent site dressing or securement device would be placed over the insertion site.

The nurse is inserting normal saline into the lumen of a central venous access device (CVAD) prior to obtaining a blood sample. What recommended amount of saline should the nurse use to flush the line? A. 10 to 15 mL B. 1 to 5 mL C. 5 to 10 mL D. 15 to 20 mL

C. 5 to 10 mL The nurse should insert 5 to 10 mL of normal saline into the lumen to flush the CVAD. This helps to ensure the collection of a fresh blood sample. Less than 5 mL is inadequate to ensure a fresh sample. More than 10 mL is unnecessary.

The nurse is flushing the implanted port of a client's central venous access device (CVAD) and meets resistance. The nurse verifies that the clamp is open, pushes down on the needle, and, after attempting another flush, meets continued resistance. What should the nurse do next? A. Flush the port with heparin. B. Notify the health care provider. C. Ask the client to perform a Valsalva maneuver. D. Change the access needle.

C. Ask the client to perform a Valsalva maneuver. If resistance is met when flushing a client's implanted port, the nurse should first verify the clamp is open, push down on the needle, and attempt to flush again. If continued resistance is met, the nurse should ask the client to perform a Valsalva maneuver, change positions, or place the affected arm over the head. The access needle would not be changed until other remedies have been attempted. Flushing the port with heparin may prevent a port from clotting but will not resolve a clot. The health care provider should be notified after all remedies have been attempted; the health care provider may give a prescription for a clot-dissolving agent.

The nurse is accessing the implanted port of a client's central venous access device (CVAD) to administer medications. After holding the port stable, the nurse should insert the needle into which location? A. top of the port B. left side of the port C. right side of the port D. center of the port

D. center of the port The nurse should visualize the center of the port and insert the needle through the skin into the port septum, located in the center of the port, until the needle hits the back of the port. To function properly, the needle must be in the middle of the port and inserted to the back wall of the port.

When accessing the implanted port of a central venous access device (CVAD), what action should the nurse take to ensure the port is patent? A. Aspirate a few milliliters of blood into the extension tubing to check for blood return. B. Open the clamp on the extension tubing and instill 3 to 5 mL of air. C. Open the clamp on the extension tubing and flush with 3 to 5 mL of saline. D. Aspirate a few milliliters of blood into the syringe to check for blood return.

A. Aspirate a few milliliters of blood into the extension tubing to check for blood return. The nurse should check the patency of the implanted port of the CVAD by pulling back on the syringe plunger to aspirate for blood return. Positive blood return indicates that the port is patent. The nurse should aspirate only a few milliliters of blood and should not allow blood to enter the syringe. Flushing the port with 3 to 5 mL of saline checks that the needle is placed correctly. Air should not be used to flush the port as this can cause air embolism.

The nurse is preparing to change the dressing for a client with a peripherally inserted central catheter (PICC). At what point would the nurse assess the insertion site? A. after putting on clean gloves B. when applying the skin protectant C. as the site is being cleaned D. after removing the old dressing

A. after putting on clean gloves The nurse assesses the insertion site of a central venous access device (CVAD) through the old dressing after putting on clean gloves. Care to the site is completed once the old dressing is removed. Site care includes cleaning the site and applying a skin protectant.

The nurse is flushing the implanted port of a client's central venous access device (CVAD) and meets resistance. What should the nurse do next? A. Ask the client to perform a Valsalva maneuver and place the client's arm below the heart. B. Check that the clamp is open, gently push down on needle, and attempt to flush again. C. Change the position of the client and lower the head of the bed. D. Notify the health care provider immediately.

B. Check that the clamp is open, gently push down on needle, and attempt to flush again. The nurse should first check the clamp to ensure that it is open, and then gently push down on the needle and attempt to flush again. If this does not work, the nurse could ask the client to perform a Valsalva maneuver, change the position, or place the affected arm over the head. The nurse could also lower or raise the head of the bed. If the port still does not flush, the needle should be removed and a new needle inserted. If the port does not flush this time, the health care provider should be notified.

The nurse is caring for a client who has an implanted port central venous access device (CVAD) and needs to have an intravenous (IV) solution infused. The nurse has appropriately prepared the solution, the infusion set, and the port site. Just before inserting the access needle, the nurse notes that it is bent at an angle. Which action is correct? A. Insert the needle through the skin close to the edge of the port, and then use the rigid port side to brace the needle while straightening it. B. Insert the needle through the skin into the center of the infusion port and begin the infusion. C. Using sterile forceps, gently straighten the needle, and then insert it into the center of the infusion port. D. Obtain a new access needle and report the flawed needle to the facility's risk manager.

B. Insert the needle through the skin into the center of the infusion port and begin the infusion. Implanted port CVADs are accessed with a specially-designed, angled needle; the nurse should not attempt to straighten it or replace it.

After removing the dressing of a client's central venous access device (CVAD), the nurse notes dried blood at the catheter insertion site. What is the next action by the nurse? A. Put on sterile gloves and use a gauze pad to cleanse the dried blood using a circular motion beginning from the outside and working to the insertion site. B. Put on sterile gloves and cleanse the dried blood using a sterile antimicrobial wipe in a circular motion beginning at insertion site and working outward. C. Put on clean gloves and cleanse the dried blood using a sterile antimicrobial wipe in a circular motion beginning at the insertion site and working outward. D. Put on clean gloves and cleanse the site using a chlorhexidine swab in a back and forth motion for 30 seconds.

B. Put on sterile gloves and cleanse the dried blood using a sterile antimicrobial wipe in a circular motion beginning at insertion site and working outward. While wearing sterile gloves, the nurse would wipe off any old blood or drainage with a sterile antimicrobial wipe, starting at the insertion site and continuing outward in a circle. Sterile gloves are used after removing the dressing to prevent contamination of the insertion site. Wiping the site from the outside to the inside could introduce microorganisms into the site. The dried blood must be removed before cleansing with chlorhexidine to prevent organisms from being introduced into the tissues.

The nurse is unable to flush the implanted port of a client's central venous access device (CVAD), despite repeated efforts at repositioning the client. Which action by the nurse is most appropriate? A. Increase pressure used, gradually, while flushing until the problem resolves. B. Reaccess the port with a new needle, according to facility policy. C. Contact the health care provider for further prescription. D. Place the client's arm below the level of the heart and attempt to flush the port.

B. Reaccess the port with a new needle, according to facility policy. If resistance is met when flushing the client's implanted port and the nurse has attempted all remedies including changing client position, the nurse should reaccess the port with a new needle and attempt to flush again, according to facility policy. After the port has been reaccessed and the nurse is still unable to flush the port, the nurse should contact the health care provider for a further prescription. Placing the client's arm below the level of the heart will not remedy the problem. Increasing pressure or "forcing" the flush may result in damage to the port and should not be attempted.

A nurse is preparing to draw a blood sample from a central venous access device (CVAD) that has more than one lumen. Which lumen is most appropriate for the nurse to use to take the sample? A. proximal B. distal C. longest D. shortest

B. distal The nurse should use the distal lumen when drawing blood samples from a CVAD, when possible. The length of the lumen is not a determinant in this decision. The proximal lumen should be used only if the distal lumen is unavailable.

The nurse is caring for a client who has a peripherally inserted central catheter (PICC) in place to receive antibiotics. As the nurse prepares to change the dressing of the PICC, how should the nurse position the client? A. sitting upright, with the arm extended from the body over the head B. lying flat, with the arm extended from the body below heart level C. sitting upright, with the arm flexed at the elbow below heart level D. lying flat, with the arm extended from the body above heart level

B. lying flat, with the arm extended from the body below heart level The nurse would assist the client to a comfortable position that provides easy access to the central venous access device (CVAD) insertion site and dressing. Because this client has a PICC, the nurse would position the client lying flat, with the arm extended from the body below heart level. This position is recommended to reduce the risk of air embolism. Sitting upright does not reduce the risk of air embolism.

The nurse is collecting a blood sample from a central venous access device (CVAD). How much blood should the nurse collect in the discard tube? A. 4 mL B. 1 mL C. 5 mL D. 2 mL

C. 5 mL The nurse should collect at least 5 mL in the discard tube to ensure a clean blood sample. Discarding any amount less than 5 mL may result in a contaminated blood sample.

The nurse, drawing a blood sample from a client's central venous access device (CVAD), is unable to start the blood flow, despite trying a new specimen tube. What would the nurse do next to try to start blood flow? A. Flush the tubing with saline solution. B. Encourage the client to place the arm below the level of the heart. C. Ask the client to raise the arm and cough. D. Flush the lumen with heparin.

C. Ask the client to raise the arm and cough. If blood does not start flowing when drawing blood from a CVAD, the first action is to try a new specimen tube, because these tubes may be defective. If the new tube does not work, having the client raise the arm above the head and giving a cough will often start the flow. Flushing with either heparin or saline would alter the blood specimen and should not be done. Placing the arm below the level of the heart is not effective for starting blood flow.

After accessing the implanted port of a client's central venous access device (CVAD), what action does the nurse take to prevent air embolism? A. Flush the extension tubing with heparin B. Start the intravenous infusion C. Clamp the extension tubing D. Flush the extension tubing with normal saline

C. Clamp the extension tubing The nurse removes the syringe and clamps the extension tubing to prevent air from entering the CVAD, which may cause an air embolism. The tubing is flushed with normal saline prior to this step. Flushing the line with heparin helps to prevent clotting and ensures patency of the line. A heparin flush is not used if an IV fluid infusion is running; however, starting the infusion will not prevent an air embolism.

A nurse is preparing to access the implanted port of a client's central venous access device (CVAD). The nurse asks the client to turn the head away from the access site, but the client is unable to do so. What is the next action by the nurse? A. Tell the client to look away. B. Ask the client to hold the breath. C. Place a mask on the client. D. Urge the client not to cough.

C. Place a mask on the client. Turning the head away from the access site helps to deter the spread of microorganisms. If a client is unable to turn the head away from the site, the nurse should place a mask on the client to help deter the spread of microorganisms. Masks may also be necessary based on facility policy. Asking the client to hold the breath, look away, or avoid coughing would not be effective in preventing the spread of microorganisms.

The nurse turns off an intravenous (IV) infusion and waits for 1 minute before obtaining a blood sample from the client's central venous access device (CVAD). For what client would this sequence of actions be appropriate? A. a client receiving a solution that alters laboratory results B. a client receiving heparin C. a client receiving a standard IV solution D. a client receiving total parenteral nutrition (TPN)

C. a client receiving a standard IV solution The nurse should turn off an intravenous (IV) infusion and wait for 1 minute before obtaining a blood sample from a client receiving a standard IV solution. The nurse should wait for 5 minutes if the client were receiving heparin, TPN, or any other solution that alters laboratory results.

When preparing to change the dressing of a multiple lumen central venous access device (CVAD), which action does the nurse take to prevent air embolism? A. Flush each lumen with 10 milliliters normal saline B. Put on sterile gloves C. Place the client in an upright position D. Clamp each lumen

D. Clamp each lumen The nurse would clamp off each lumen to prevent air from entering the catheter and causing an air embolism. Sterile technique is used to prevent infection. Flushing the lumens with normal saline solution verifies patency. Placing the client flat, with the arm below the level of the heart reduces the risk of air embolism.

The nurse is collecting a blood sample from a client's central venous access device (CVAD). The nurse notices that the flow stops when drawing the blood, even after changing the specimen tube and having the client cough. What would be the next recommended intervention? A. Clamp the tubing, remove the tube and vacutainer, and flush with heparin. B. Unclamp the tubing, remove the tube and vacutainer, and flush with heparin. C. Unclamp the tubing, remove the tube and vacutainer, and flush with normal saline. D. Clamp the tubing, remove the tube and vacutainer, and flush with normal saline.

D. Clamp the tubing, remove the tube and vacutainer, and flush with normal saline. If the blood does not flow after changing the specimen tube, the nurse would clamp the tubing, remove the tube and vacutainer, and flush with 5 mL normal saline. The nurse would then redraw a waste sample and attempt to finish collecting the blood sample. Heparin would not be reinstilled, as it would change the viscosity of the blood. It is important to clamp the tubing before removing the tube and vacutainer to prevent air embolism.

The nurse has collected a blood sample from a client's central venous access device (CVAD). After removing the vacutainer, what should the nurse do next? A. Label the blood sample tube. B. Flush the line with heparin. C. Flush the line with sterile water. D. Flush the line with normal saline.

D. Flush the line with normal saline. After collecting the blood and removing the vacutainer, the nurse should flush the line first with normal saline, then with heparin. The line is not flushed with sterile water and the blood sample tube is labeled after flushing the line.

When changing the dressing of a central venous access device (CVAD), how should the nurse remove the old dressing? A. Lift it proximally, and then work distally while stabilizing the catheter with an antimicrobial swab. B. Pull it up from the bottom to the top, applying pressure to the catheter with an antimicrobial swab. C. Pull it up from the top to the bottom, applying pressure to the catheter with a gauze pad. D. Lift it distally, and then work proximally to the insertion site while stabilizing the catheter with the gloved finger of the nondominant hand.

D. Lift it distally, and then work proximally to the insertion site while stabilizing the catheter with the gloved finger of the nondominant hand. When changing the dressing, the nurse would remove the old dressing by lifting it distally and then working proximally, making sure to stabilize the catheter with the gloved finger (clean gloves) of the nondominant hand. These steps help to maintain aseptic technique during the procedure. The gloved finger provides more stability to the catheter than an antimicrobial swab.

When the nurse is drawing a blood sample from a client's central venous access device (CVAD), the blood stops flowing after the collection tube has been placed. The nurse removes the tube and flushes the lumen with 5 mL of saline solution. What is the next action by the nurse? A. Notify the health care provider. B. Flush with heparin. C. Attempt to collect the blood sample. D. Redraw the waste sample.

D. Redraw the waste sample. After flushing the lumen with 5 mL of saline solution, it would be necessary to redraw a waste sample before attempting to collect the sample. If the waste sample is not drawn at this point, the blood sample may be altered by the saline solution. Flushing with heparin would be done after the sample is collected. It is not necessary to notify the health care provider until all efforts to obtain the sample have been exhausted.

The nurse is observing an unlicensed assistive personnel (UAP) drawing a blood sample from a client's central venous access device (CVAD). After the collection tube has been placed, the blood stops flowing. Which action by the UAP would require the nurse to intervene? A. The UAP asks the client to raise the arm and cough. B. The UAP clamps the tubing and removes the tube and the vacutainer. C. The UAP replaces the specimen tube. D. The UAP flushes the lumen with 5 mL of sterile water.

D. The UAP flushes the lumen with 5 mL of sterile water. The nurse should intervene if the UAP flushes the lumen with 5 mL of sterile water. When drawing a blood sample from a client's CVAD and blood stops flowing after the collection tube has been placed, the UAP should first replace the specimen tube, because these tubes are sometimes defective. If blood still does not flow, the UAP should ask the client to raise the arm and cough. If additional intervention is still required for starting the blood flow, the UAP should clamp the tubing, remove the collection tube and vacutainer, and 5 mL of saline solution, not sterile water.

The nurse is collecting a blood sample from a client's central venous access device (CVAD) and notices that the flow stops when drawing the blood. What should the nurse do first? A. Push down on the access needle. B. Raise the head of the bed. C. Make sure the tubing is clamped. D. Try a new specimen tube.

D. Try a new specimen tube. If the flow of blood is slow or stopped, the nurse would first try a new specimen tube, because these tubes are sometimes defective. The tubing is not clamped when drawing a specimen. Pushing down on the access needle and raising or lowering the head of the bed are helpful when meeting resistance in flushing a CVAD.

A nurse needs to obtain blood samples for lab studies to check the electrolyte levels for a client who has a multilumen non-tunneled percutaneous central venous catheter in place. The client is receiving intravenous (IV) fluids through the central venous access device (CVAD). What should be the nurse's first step in this procedure? A. Flush the CVAD with normal saline. B. Place the CVAD dial on "hold." C. Increase the flow of fluids to the CVAD. D. Turn off the flow of fluids to the CVAD.

D. Turn off the flow of fluids to the CVAD. First, the nurse should turn off the flow of fluids to the CVAD, and then wait for the specified amount of time. There is not a "hold" button on the CVAD, and the device is not flushed with normal saline. Increasing the flow of fluids should be inappropriate.