Taylor's Clinical Skills - Module 19: Central Venous Access Devices

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?

distal

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?

Clean the end cap on the extension tubing and insert the saline-filled syringe

How would the nurse care for the access site after removing the needle from the implanted port of a central venous access device (CVAD)?

Apply gentle pressure to the site with a gauze square

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?

Ask the client to perform a Valsalva maneuver

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?

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

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?

Try a new specimen tube

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?

infection

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?

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

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?

Clamp each lumen

After accessing the implanted port of a client's central venous access device (CVAD), what action does the nurse take to prevent air embolism?

Clamp the extension tubing

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.

Clamp the tubing, remove the tube and vacutainer, and with normal saline

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?

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.

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?

Reaccess the port with a new needle, according to facility policy

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?

Redraw the waste sample.

The nurse is assessing the insertion site of a client's peripherally inserted central catheter (PICC). What is a normal finding?

a transparent dressing covering the site

Which is a normal finding upon assessment of a client's peripherally inserted central catheter (PICC)?

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

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:

assess if the catheter has migrated inward or moved outward

The nurse is flushing a client's peripherally inserted central catheter (PICC). What action should the nurse perform first?

cap the infusion line

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?

center of the port

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?

lying flat, with the arm extended from the body below heart level

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?

normal saline and heparin

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?

palpation

When accessing the implanted port of a central venous access device (CVAD), what action should the nurse take to ensure the port is patent?

Aspirate a few milliliters of blood into the extension tubing to check for blood return

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?

Flush the line with heparin

When changing the dressing of a central venous access device (CVAD), how should the nurse remove the old dressing?

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 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 client receiving a standard IV solution

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?

after putting on clean gloves

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?

5 to 10 mL

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?

90-degree

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?

Ask the client to raise the arm and cough

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?

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?

Flushing the port with normal saline

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?

Place a mask on the client

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?

The UAP flushes the lumen with 5 mL of sterile water.

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?

4 mL

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?

Ask the client about any pain or discomfort at the insertion site

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?

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

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?

Flush the line with normal saline.

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?

Turn off the flow of fluids to the CVAD

The nurse is deaccessing the implanted port of a client's central venous access device (CVAD) following chemotherapy. Which action would be appropriate?

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