Module 19: Central Venous Access Devices

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. place a mask on the client B. ask the client to hold the breath C. urge the client not to cough D. tell the client to look away

A. place a mask on the client

The nurse is assessing the insertion site of a client's peripherally inserted central catheter (PICC). What is a normal finding? A. a sterile bandage covering the site B. a transparent dressing covering the site C. tape covering the site D. gauze pad covering the site

B. a transparent dressing covering the site

Which is a normal finding upon assessment of a client's peripherally inserted central catheter (PICC)? A. a crusted appearance at the insertion site B. an insertion site free of blood and intravenous (IV) solution C. a small amount of blood and intravenous (IV) solution D. intravenous (IV) solution surrounding the catheter

B. an insertion site free of blood and intravenous (IV) solution

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. center of the port C. left side of the port D. right side of the port

B. center of the port

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. clamp the extension tubing C. start the intravenous infusion D. flush the extension tubing with normal saline

B. clamp the extension tubing

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 normal saline C. flush the line with heparin D. flush the line with sterile water

B. flush the line with normal saline.

The nurse is caring of a client who has a peripherally inserted center 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 flexed at the elbow below heart level B. lying flat, with the arm extended from the body below heart level C. lying flat, with the arm extended from the body above heart level D. 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

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 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 cleans 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 cleans the dried blood using a sterile antimicrobial wipe in a circular motion beginning at the insertion site and working outward D. 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 cleans the dried blood using a sterile antimicrobial wipe in a circular motion beginning at insertion site and working outward.

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. flush the heparin B. redraw the waste sample C. attempt to collect the blood sample D. notify the health care provider

B. redraw the waste sample.

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. place the CVAD dial on "hold" B. turn off the flow of fluids to the CVAD C. flush the CVAD with normal saline D. increase the flow of fluids to the CVAD

B. turn off the flow of fluids to the CVAD

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. as the site is being cleaned B. after removing the old dressing C. when applying the skin protectant D. after putting on clean gloves

D. after putting on clean gloves

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 top to the bottom, applying pressure to the catheter with a gauze pad C. lift it distally, and then work proximally to the insertion site while stabilizing the catheter with the gloved finger of the nondominant hand. D. pull it up from the bottom to the top, applying pressure to the catheter with an antimicrobial swab

Lift it distally, and then work proximally to the insertion site while stabilizing the catheter with the gloved finger of the nondominant hand.

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. 1 mL B. 4 mL C. 2 mL D. 4 mL

4 mL

A nurse is caring for a client with a central venous access device (CVAD) whose implanted port will not be used for a long period of time. What action will the nurse take to maintain patency of the port? A. flush with heparin solution B. apply firm pressure after deaccession the port C. place a sterile dressing over the port D. flush with normal saline solution

A. flush with heparin solution

Which action is important for the nurse to take prior to deaccessing the implanted port of a central venous access device (CVAD) to remove all substances from the port? A. flushing the port with normal saline B. flushing the port with heparin solution C. clamping the extension D. scrubbing the needless connector with an antimicrobial swab

A. flushing the port with normal saline

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 into the center of the infusion port and begin the infusion. B. using sterile forceps, gently straighten the needle, and then insert it into the center of the infusion port C. 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 D. obtain a new access needle and report the flawed needle to the facility's risk manager

A. insert the needle through the skin into the center of the infusion port and begin the infusion.

The nurse is caring for a client receiving an antibiotic via a peripherally inserted central catheter (PICC). What two solutions should the nurse use to flush the line and keep it patent? A. normal saline and heparin B. sterile saline and sterile water C. heparin and sterile saline D. sterile water and normal saline

A. normal saline and heparin

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. open the clamp on the extension tubing and flush with 3 to 5 mL of saline B. aspirate a few milliliters of blood into the syringe to check for blood return C. aspirate a few milliliters of blood into the extension tubing to check for blood return D. open the clamp on the extension tubing and instill 3 to 5 mL of air

B. aspirate a few milliliters of blood into the extension tubing to check for blood return

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. 1 to 5 mL B. 15 to 20 mL C. 5 to 10 mL D. 10 to 15 mL

C. 5 to 10 mL

How would the nurse care for the access site after removing the needle from the implanted port of a central venous access device (CVAD)? A. allow the site to air dry before applying a transparent dressing B. applying a sterile bandage after wiping the site with an alcohol wipe C. apply gentle pressure to the site with a gauze square D. applying steady pressure to the site with an antimicrobial wipe

C. apply gentle pressure to the site with a gauze square

The nurse is flushing a client's peripherally inserted central catheter (PICC). What action should the nurse perform first? A. flush the catheter using steady pressure B. insert the saline syringe into the catheter port C. cap the infusion line D. swab the access cap with an alcohol wipe

C. cap the infusion line

The nurse is flushing a client's peripherally inserted central catheter (PICC) to maintain patency, because it is being used intermittently. After flushing with normal saline, which action should the nurse perform next? A. document the procedure B. restart the infusion C. attempt a blood return D. flush the line with heparin

D. flush the line with heparin

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. contact the health care provider for further prescriptions B. increase pressure used, gradually, while flushing until the problem resolves C. place the client's arm below the level of the heart and attempt to flush the port D. reaccess the port with a new needle, according to facility policy

D. reaccess the port with a new needle, according to facility policy

The nurse is observing an unlicensed assistive personal (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 clamps the tubing and removes the tube and the vacutainer B. the UAP asks the client to rase the arm and cough 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 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

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. ask the client to raise the arm and cough B. flush the lumen with heparin C. encourage the client the place the arm below the level of the heart D. flush the tubing with saline solution

A. ask the client to raise the arm and cough

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. clamp each lumen B. place the client in an upright position C. put on sterile gloves D. flush each lumen with 10 milliliters normal saline

A. clamp each lumen

The nurse is assessing a client's peripherally inserted central catheter (PICC) insertion site. The nurse measures the length of the catheter that extends out from the insertion site to: A. record the catheter size for when it needs the be replaced B. assess if the catheter has migrated inward or moved outward C. assess whether the catheter is ready to the removed D. determine if the catheter is still patent

B. assess if the catheter has migrated inward or moved outward

When completing a routine assessment of a client's peripherally inserted central catheter (PICC), the nurse finds no redness, swelling, or drainage at the insertion site. The transparent dressing is dry and intact and adheres to the skin around all edges. What is the most appropriate intervention at this time? A. ask the client about any pain or discomfort at the insertion site B. flush the catheter using a sterile refilled normal saline flush C. document the assessment findings D. change the transparent dressing using sterile technique

A. ask the client about any pain or discomfort at the insertion site

The nurse is deaccessing the implanted port of a client's central venous access device (CVAD) following chemotherapy. Which action would be appropriate? A. removing, carefully, all the tape securing the needle in place B. stabilizing the port with the dominant hand C. putting on sterile gloves D. removing

A. removing, carefully, all the tape securing the needle in place

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. unclamp the tubing, remove the tube and vacutainer, and flush with heparin B. clamp the tubing, remove the tube and vacutainer, and flush with normal saline C. clamp the tubing, remove the tube and vacutainer, and flush with heparin D. unclamp the tubing, remove the tube and vacutainer, and flush with normal saline

B clamp the tubing, remove the tube and vacutainer, and with normal saline

The nurse is removing the needle from the implanted port of a central venous access device (CVAD). At what angle would the nurse remove the needle? A. 30-degree B. 90-degree C. 45-degree D. 60-degree

B. 90-degree

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. change the access needle B. flush the port with heparin C. ask the client to perform a Valsalva maneuver D. notify the health care provider

C. ask the client to perform a Valsalva maneuver

The nurse is deaccessing the implanted port of a client's central venous access device (CVAD). After removing the dressing and tape from the needle, what action would the nurse perform next? A. clean the end cap on the extension tubing and insert the heparin-filled syringe B. unclamp the extension tubing and flush with 10 mL heparin C. clean the end cap on the extension tubing and insert the saline-filled syringe D. unclamp the extension tubing and flush with a minimum of 5 mL normal saline

C. clean the end cap on the extension tubing and insert the saline-filled syringe

Assessing the insertion site of a client's peripherally inserted central catheter (PICC), the nurse notes redness, swelling, and odor at the site. Which complication does the nurse suspect? A. infiltration B. speed shock C. infection D. rash

C. infection

The 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. auscultation B. percussion C. palpation D. observation

C. palpation

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 total parenteral nutrition (TPN) B. a client receiving a solution the alters laboratory results C. a client receiving heparin D. a client receiving a standard IV solution

D. a client receiving a standard IV solution

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 chlorahexidine. Which action would the nurse perform next? A. apply the transport site dressing or securement/stabilization device over the insertion site B. apply skin protectant to the same area, applying it directly on 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, avoiding direct application to the insertion site

D. apply skin protectant to the same area, avoiding direct application to the insertion site.

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. notify the health provider immediately B. ask the client to perform a Valsalva maneuver and place the client's arm below the heart C. change the position of the client and lower the head of the bed D. check that the clamp is open, gently push down on the needle, and attempt to flush again

D. check that the clamp is open, gently push down on the needle, and attempt to flush again

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 fro the nurse to use to take the sample? A. shortest B. longest C. proximal D. distal

D. distal