Central Venous Access Devices and Management

The nurse is providing discharge education for a client with a central venous access device (CVAD). What information should the nurse include? Select all that apply. "It is OK to get the dressing wet if you towel dry it after." "Call the healthcare provider for any swelling, discomfort, pain, heat, or redness in the shoulder, chest, neck, or arm." "Signs of infection include redness, pain, pus, swelling, or discharge." "Use scissors to trim any loose or dirty dressing corners." "Sterile technique is only necessary in the hospital setting."

"Call the healthcare provider for any swelling, discomfort, pain, heat, or redness in the shoulder, chest, neck, or arm." "Signs of infection include redness, pain, pus, swelling, or discharge."

A nurse is educating a client with a new implanted port for the administration of chemotherapy. Which statement by the client indicates the need for further instruction? "Accessing the port is a sterile procedure."​ "I can access the port with a regular peripheral intravenous start kit." "If I have pain or swelling, I should contact my healthcare provider."​ "I can shower when the port is not accessed or in use."

"I can access the port with a regular peripheral intravenous start kit."

The certified infusion nurse reviews the intravenous needs of clients in the medical unit. Which clients are identified as those who could benefit from the placement of a central venous access device? Select all that apply. ​ A client being discharged home to the care of hospice and unable to take oral fluids A client receiving frequent potassium replacement infusions A client with a low albumin level who is being started on total parenteral nutrition A client with osteomyelitis requiring 6 weeks of antibiotic therapy A client with fragile veins requiring multiple needle sticks for the placement of a peripheral IV A client scheduled to receive 2 units of blood A client who is unstable requiring large volume infusions A client with cancer requiring intravenous chemotherapy

A client receiving frequent potassium replacement infusions A client with a low albumin level who is being started on total parenteral nutrition A client with osteomyelitis requiring 6 weeks of antibiotic therapy A client with fragile veins requiring multiple needle sticks for the placement of a peripheral IV A client who is unstable requiring large volume infusions A client with cancer requiring intravenous chemotherapy

The nurse cares for a client with a newly placed capped, open-ended, single-lumen, left basilic peripherally inserted central catheter (PICC). The site has an antimicrobial disc and transparent dressing. Which findings are concerning? Select all that apply. A left upper arm measurement larger than the right Loose luer lock cap Dime-sized bruise near the site Coolness of the hands Antimicrobial disc covering the catheter insertion site Loose edges on the transparent dressing External catheter 0.5 cm longer than the previous measurement Closed clamp on the catheter The catheter flushes with normal saline

A left upper arm measurement larger than the right Loose luer lock cap Loose edges on the transparent dressing External catheter 0.5 cm longer than the previous measurement

The nurse is caring for a client with a peripherally inserted central catheter. What actions should the nurse take when caring for this client? Select all that apply. Change the dressing every 7 days per policy. Insert a new catheter every 3 days per policy. Use clean technique when changing the dressing.​ Scrub the access port with antiseptic immediately prior to each use. Recommend removal of the line when it is no longer necessary.​

Change the dressing every 7 days per policy. Scrub the access port with antiseptic immediately prior to each use. Recommend removal of the line when it is no longer necessary.​

For each action, click to specify if the nurse is using the correct sterile technique or incorrect sterile technique. Using sterile gloves to grab sterile equipment​ Dropping a sterile object onto a sterile field less than 6 inches above the field​ Avoiding the outside 1-inch border​ Reaching over the sterile field ​ Turning back on sterile field​ Using a sterile glove that touched the client's gown​

Correct Sterile Technique Correct Sterile Technique Correct Sterile Technique Incorrect Sterile Technique Incorrect Sterile Technique Incorrect Sterile Technique

The nurse mentors a colleague who is completing a central line dressing change. Select the best answer for each group. Only one item will be selected for each group.​ Removes transparent dressing, pulling in the direction of the catheter Dons clean gloves prior to cleaning the insertion site

Correct. This prevents catheter displacement and skin irritation. Incorrect. Sterile gloves are used prior to cleaning the insertion site.

The nurse notified the healthcare provider of the assessment findings consistent with central venous access device infection. For each assessment finding, click to specify whether the observation indicates the client's condition has improved or declined. Blood pressure 122/80 Pulse 78 Confusion and lethargy Respirations 30 Temperature 104.2 °F (40.11 °C)

Improved Improved Declined Declined Declined

The nurse is caring for a client with a central line. Identify each action as appropriate or inappropriate by the nurse. Wipe the access port with an antimicrobial swab for 10 seconds before accessing​. Secure intravenous (IV) tubing to the gown to prevent catheter displacement​. Use a 3-mL syringe to flush the catheter​. Use a push-pause-push motion to irrigate the catheter​. Clamp the catheter before changing the caps​. Change the dressing when it becomes soiled.

Inappropriate Inappropriate Inappropriate Appropriate Appropriate Appropriate

The nurse notified the healthcare provider of the assessment findings consistent with central venous access device infection. For each nursing intervention, click to specify whether it is indicated or contraindicated for the client. Administer antipyretics Remove catheter as ordered Start sepsis protocol of antibiotic therapy and IV fluids Obtain CVAD and peripheral blood culture samples Use medical asepsis to change dressing Flush line with 10 mL D5W

Indicated Indicated Indicated Indicated Contraindicated Contraindicated

The nurse compares different types of vascular access devices. Select the correct description and care for each type of device.​

Non-Tunneled Percutaneous Central Venous Catheter (CVC) ​ Short term used Inserted into the subclavian vein PICC Flushed with a 10 mL syringe Placed by specially trained nurses Implanted port Long-term use Must be specifically trained to access No dressing is required once its healed

The nurse is preparing to perform a peripherally inserted central-line catheter (PICC) line dressing change on a client, but notices that the catheter appears to be longer than before. What should the nurse do next? Ask the client to bear down. Continue with the dressing change. Notify the healthcare provider. Don sterile gloves and re-advance the catheter.

Notify the healthcare provider.

​The nurse anticipates that a/an ___________ will be placed because of ________.

PICC the risk of bleeding

For each nursing action, click to specify whether using a peripheral intravenous (IV) line or central venous access device is most appropriate. Administer routine IV fluids​ Administer non-vesicant IV medications​ Administer long-term IV therapy​ Administer rapid IV fluids during an emergency​ Collect multiple blood samples per day​ Administer total parental nutrition (TPN)​ Provide hemodialysis​ Administer vesicant IV medications​

PIL PIL CVAD CVAD CVAD CVAD CVAD CVAD

The nurse cares for several clients with central venous access devices. Identify if each action performed prevents or potentiates the risk for central line-associated bloodstream infection (CLABSI). Maintain sterile barrier precautions when assisting with the placement of the catheter.​ Clean the catheter hub with alcohol wipes before use. ​ Cover the insertion site with a sterile gauze dressing and tape.​ Use an alcohol-based hand rub before and after touching the catheter.​ Suggest catheter removal as soon as it is no longer needed.

Prevents CLABSI Potentiates the Risk for CLABSI​ Potentiates the Risk for CLABSI​ Prevents CLABSI Prevents CLABSI

Highlight the assessment findings indicating a central venous access device complication.​ A nurse on a medical surgical unit is performing an admission assessment on a client. The client is receiving intravenous fluids and long-term antibiotic therapy of vancomycin through a triple-lumen central venous catheter in the right internal jugular. The dressing is loose, and the insertion site is red and hot to the touch. The client's vital signs are T 100.4 °F (38 °C) oral, P 102, BP 105/78, RR 16, pulse oximetry reading 97% on room air. The client states they have lower backpain 5/10 using a Numerical Rating Scale. The client also reports feeling constipated and has not had a bowel movement in 3 days. ​

The dressing is loose red and hot to the touch T 100.4 °F (38 °C) oral, P 102, BP 105/78

The nurse assists with the removal of a central line. The client develops sudden shortness of breath and anxiety. Complete the sentence. Based on the findings, the client is most likely experiencing _______ . The nurse should ___________ and provide ________.

an air embolus place the client in the left lateral decubitus position oxygen

The client is at highest risk of developing ______________ as evidenced by ___________.

infection temperature and redness to insertion site

The nurse provides discharge teaching for a client with a newly placed implanted port. Complete the sentence. The client should be instructed that if ________ occurs, they should notify the healthcare provider because they may be experiencing ________.

pain, redness, drainage at the insertion site an infection

During placement of a central venous catheter in the subclavian vein, the client is at highest risk for __________ A client with this complication would most likely have __________.

pneumothorax SOB