IV Therapy Questions Chapter 8
A nurse is caring for a client who has a closed-valve central venous catheter. Which solution s/the nurse use to flush a closed valve (Groshong) catheter?
Sodium chloride (The valve (Groshong) differs from other CVCs in that it has a patented three-position pressure-sensitive valve, which allows fluids to flow in or out, but stays closed when not in use. The Groshong CVC there virtually eliminates the need of heparin flushing to maintain catheter patency because only sodium chloride is needed after use.
A home health nurse is discharging a client who has a newly implanted port. The nurse explains to the client that implanted ports, when not in use, can be flushed every:
4 weeks. (For a port not in use, 3-5mL of 100 U heparinized sodium chloride s/be used once every 4 weeks to flush the port.)
When flushing a client's central catheter, which barrel size s/a nurse use to prevent rupture of the catheter?
10 mL (A 10 mL syringe barrel can be used to safely flush central lines. A barrel size of smaller than 6 mL increases the pressure in the catheter and could rupture it.)
A nurse is caring for a client who is scheduled to receive a peripherally-inserted central catheter (PICC). Which complications are most often associated withe the insertion of a PICC?
Bleeding, catheter malposition, and cardiac arrhythmias. (Bleeding is a common complication associated with non-tunneled catheters. A mild pressure dressing may be required to control bleeding. Cardiac arrhythmias are related to irritation of the myocardial wall by an over-inserted catheter or guide wire. Malposition of the catheter tip can occur during insertion. The catheter may coil in the vessel and then advance into the right atrium or one of the smaller venous tributaries.
A physician ordered a tunneled catheter for a client scheduled to receive chemotherapy. A nurse explains to the client that the primary advantage of tunneled catheters is that they:
Can be used for multiple purposes. (Tunneled catheters can be used for the administration of hypertonic solutions, TPN, blood administration, and blood drawn for laboratory analysis. These catheters must be flushed to maintain patency, are more difficult to place than peripheral catheters, and do have a potential for some body image alterations.)
A nurse educator, who is teaching a group of nursing students, describes a long-term catheter that is surgically inserted through an incision in the deltopectoral groove terminating near the right atrium. To which type of catheter is the educator referring?
Central venous tunneled catheters. (CVTCs are composed of polymeric silicone with a Dacron polyester cuff that subcutaneously anchors the catheter in place. This cuff is about 2 inches from the catheter's exit site, which becomes embedded with fibroblasts within 1 week to 10 days after insertion, reducing the changes of accidental removal and minimizing the risk of ascending bacterial infection. CVTCs are available with single, double, or triple lumens. They vary in size from pediatric to adult, with most internal lumens ranging form 0.5 to 1.6mm. A CVTC's tip placement is in the SVC.
A nurse is changing a client's PICC dressing. When changing a PICC dressing, the old dressing s/be detached from the:
Distal to the proximal edge. (When removing a PICC dressing, detach it from the lower part toward the shoulder while securing the catheter. This action prevents inadvertent removal of the catheter from its position in the vein.)
A nurse attend a class on the care of multilumen central venous catheters. The nurse clearly understands the information presented in the class when, on performance evaluation, the nurse discards and replaces the injection cap on a multilumen catheter:
Every 72 hours.
A nurse is to change the needleless injection cap of a multiple-lumen central line. Which techniques s/be used by the nurse to change the injection cap?
Hold the connector below the client's heart, clamp, and change the cap. (The fluid level in the catheter drops when the catheter connector is held above the level of the client's heart and opened to air. To prevent a drop in fluid level and entry of air into the system while changing injection caps, it is important to clamp and hold the connector below the level of the client's heart before removing the injection cap.)
An intensive care nurse is maintaining the patency of a client's nonvalved, tunneled central catheter. Which action by the nurse best achieves this goal?
Irrigating or flushing w/5 mL sodium chloride followed by 5 mL of 10 units of heparinized saline.
A home-care nurse has an order to discontinue therapy and remove the PICC. Upon assessment of the client's PICC, it is determined that the PICC is stuck. Which nursing intervention is most effective for removing a "stuck" PICC?
Leave the PICC alone and apply a gentle massage or moist heat to the area of the upper arm. Reattempt removal in 20 to 30 minutes after the vein has relaxed.
For a client w/a fractured femur who needs crutches to walk, which catheter would be the best choice for the infusion of anti-infective therapy that will last for 3 months?
PICC placed in the cephalic vein. (Cannulation of the cephalic vein is best for a client on crutches because the cannula runs along the outside of the extremity. The basilic vein, althoughan easier place for the PICC, runs under the arm and is at risk for pinch off or tearing due to friction from the constant rubbing of the crutches.)
A nurse is discharging a client with a new peripherally-inserted central catheter (PICC). Which instructions s/the nurse provide to the client regarding the management of the PICC dressing?
Place a recommened transparent dresssing after the first 24 hrs. Inspect the catheter insertion site for redness, swelling, and drainage. Use care not to dislodge the catheter during ther dressing change. Change the dressing after the first 24 hours. (A small amount of bleeding at the insertion site occurs during the first 24 hrs. after placement, so the original dressing must be replaced with a new one that can remain in place up to 7 days. As with any IV site, inspection of the site is important. Because the catheter is not sutured in place, care s/be taken during the dressing change not to dislodge the catheter. An occlusive transparent dressing is recommended for frequent inspection of the site.)
A nurse, assisting a physician with the insertion of a CVC, instructs a client to perform the Valsalva maneuver during the insertion of the catheter. The purpose of instructing the client to perform the Valsalva maneuver is to:
Prevent air from entering the circulation.
A nurse has given instructions to a client being discharged home w/a PICC but evaluates that the client does not fully understand the instructions when the client states that he or she will:
Protect the insertion site when he or she is bathing. (The client s/be taught that there are only minor activity restrictions with this catheter. He s/protect the site during bathing and s/wear or carry medical identification. The client s/also have a repair kit in the home for PRN use, depending on the time length of the catheter.)
A nurse is educating a client who is scheduled to receive a central venous catheter. The nurse explains that most CVADs are made of:
Silicone (Silastic) Silicone is soft and pliable. Silicone catheters are less likely to damage the intima of the vein wall, and they are reported to be less thrombogenic. Most long-term CVAs and PICCs are made of silicone or polyurethane.
Which statements s/a nurse include when explaining the advantages of a peripherally-inserted central catheter (PICC) to a client?
The PICC is cost effective The PICC involves less pain and discomfort because of its multiple uses. The PICC is very reliable. (THe PICC is indicated for clients who require long-term catheter placemnt (over 1 month to 1 year). It is cost effective because the catheter does not need routine replacement, as peripheral IV catheters do. This catheter is more comfortable (only minimal discomfort is present), reliabale, and has flexibility because of its multiple uses.)
The PICC team is scheduled to remove a PICC prior to client discharge. Assessment of the catheter indicates the PICC and determines that the PICC is "stuck". The most common cause of a stuck PICC is:
Vasospasm (Vasospasm is usually secondary to mechanical or chemical irritation and ensues after the initiation of catheter removal, when movement of the catheter irritates the intima of the vein. Other causes that hinder catheter removal are phlebitis, thrombophlebitis, valve inflamation, a knotted catheter, or endotheliosis of the catheter tip along the vein wall.)