NURS 3270 Fundamentals Evolve -- Mod 9

What are the two most common complications of a central vascular access device? A. Occlusion and thrombosis B. Infection and leaking C. Extravasation and leaking D. Occlusion and infection

D. Occlusion and infection

Matching: A. Implanted venous port B. PICC line C. Percutaneous central vascular access device D. Midline catheter E. Tunneled central vascular access device

1. Requires a Huber needle to access device 2. Usually located in the antecubital fossa 3. Inserted directly through the skin into a large vein 5. Usually shorter than a PICC line 4. Have single, double, or triple lumens

Matching: A. Air embolism B. Thrombosis C. Catheter migration D. Occlusion 1. Absent blood return, sluggish infusion 2. Pain, numbness in neck or shoulder of affected side 3. Irregular heart rate or dysrhythmia 4. Dyspnea, cyanosis

4, 2, 3, 1

Matching: A. Promotes maximum bactericidal effectiveness B. Provides means to determine when next dressing change is due C. Prevents accidental dislodgement and catheter breakage D. Prevents aerosolization of microorganisms over site E. This pattern allows penetration of the antiseptic solution into the cracks and fissures of the epidermal layer of the skin. 1. Write the date, time, and your initials on the label on the dressing 2. Don mask 3. Using alcohol swab, cleanse catheter and insertion site, swabbing the insertion site in a horizontal plane, then a vertical plane, followed by a circular motion (from the middle outward) 4. For PICC lines, coil extension tubing and tape securely to patient's arm 5. Allow chlorhexidine to dry completely

5, 1, 4, 2, 3

Identify the uses of a central vascular access device. (Select all that apply.) A. Administering IV fluids B. Obtaining blood samples C. Infusing blood products D. Parenteral nutrition E. Enteral nutrition F. Chemotherapy G. Infusing medications H. Reducing the patient's clotting time with repeated heparinization of catheter

A, B, C, D, F, G

Identify possible complications of a PICC. (Select all that apply.) A. Air embolism B. Thrombosis C. Occlusion D. Fat embolism E. Sepsis F. Phlebitis G. Immunosuppression

A, B, C, E, F

The nurse is going to change the dressing on a patient's PICC line when the nurse notices that the patient's arm appears swollen and is cool to the touch. The patient has been receiving IV parenteral nutrition through the PICC line. The patient states that the IV infusion pump has been "beeping" a lot, so he kept pushing the "silence" button on the pump. The nurse suspects extravasation. What actions should the nurse take? (Select all that apply.) A. Stop the IV infusion. B. Remove the PICC line. C. Notify the health care provider. D. Administer appropriate antidote per protocol. E. Scold the patient for touching the infusion pump. F. Obtain blood cultures.

A, C, D

The patient has a tunneled CVAD. When cleaning the exit site, the nurse noticed purulent drainage and redness. The nurse reviewed the patient's medical record and noted he has had a fever for the last 24 hours and his white blood cell count today is elevated. The patient appears less alert, and his urine output is decreased. His medication administration record indicates that he has been receiving parenteral nutrition. What actions should the nurse take? (Select all that apply.) A. Notify the health care provider. B. Prepare to administer an antidote. C. Prepare to obtain blood cultures. D. Prepare to administer antibiotics if ordered; check allergies. E. Obtain x-ray examination. F. Disregard, as tunneled CVADs are less likely to develop an infection than percutaneous CVADs.

A, C, D

The nurse completes the following steps for administering fluids through an implanted venous port. Which step in the sequence would require correction? A. Apply clean gloves. Have patient turn head toward port site. Prepare sterile field, and open sterile supplies. Using alcohol, prepare patient's skin overlying port septum, swabbing the site in a circular motion (from the middle outward). Allow to dry for 60 seconds. B. Use chlorhexidine swabs to cleanse skin overlying port septum, swabbing the site in a horizontal plane then a vertical plane followed by a circular motion (from the middle outward). Allow to dry for 2 minutes. Apply sterile gloves. As another nurse holds vial of saline, fill sterile syringe with saline solution. C. Attach one end of sterile extension tubing to syringe and attach appropriate size Huber needle to other end. Fill tubing with saline solution. Palpate port septum, observing strict aseptic technique. While holding wings or needle hub, insert Huber needle through skin at a 90-degree angle and push firmly down until needle penetrates silicone septum and hits bottom of portal chamber. D. Check for proper placement by attempting to withdraw blood by aspirating with the attached syringe. If a good blood return is present, flush tubing with remaining saline in syringe. Secure Huber needle with Steri-strips. Cover the Huber needle and insertion site with a transparent dressing. If Huber needle fails to sit flush on skin, place folded 2-by-2 gauze under hub and then cover with dressing. E. Connect IV infusion tubing with sterile tubing connected to Huber needle. (IV tubing should already be flushed with IV fluids.) Regulate IV infusion as ordered. Dispose of all soiled supplies and used equipment. Remove gloves and perform hand hygiene. Document.

A. Apply clean gloves. Have patient turn head toward port site. Prepare sterile field, and open sterile supplies. Using alcohol, prepare patient's skin overlying port septum, swabbing the site in a circular motion (from the middle outward). Allow to dry for 60 seconds. Correction: Sterile gloves!

The nurse is obtaining a blood sample from a CVAD. The nurse has performed hand hygiene and applied clean gloves. The nurse swabs the catheter hub with an alcohol swab and a chlorhexidine swab. The nurse removes the injection cap, attaches a 10 mL syringe with normal saline and flushes the catheter. The nurse connects an empty syringe and aspirates 5 mL of blood that is discarded appropriately. The nurse attaches a syringe and withdraws the necessary amount of blood for the sample. The nurse attaches a syringe with 10 mL of normal saline and flushes the catheter; followed by another syringe with 5 mL of heparin solution (100 units per mL), and flushes the catheter. The nurse replaces the cap at the end of the catheter. What complication could the patient experience because of the nurse's performance of the procedure? A. Hemorrhage from excessive heparin B. Infection C. Occlusion D. Air embolus

A. Hemorrhage from excessive heparin

What is the primary advantage of a central vascular access device over the use of a peripheral IV? A. It can remain in place longer. B. It is unaffected by movement. C. Sterile technique is unnecessary. D. Sepsis is less likely to develop. E. Increased likelihood of extravasation.

A. It can remain in place longer.

The nurse is changing the dressing over a triple-lumen CVAD and assesses the exit site. Which observation would be cause for concern and should be reported to the health care provider? A. Patient afebrile; redness and tenderness at exit site B. Dried dark red blood noted on previous dressing C. Clamps are closed on each of the triple lumens D. Absence of exudate and swelling at insertion site

A. Patient afebrile; redness and tenderness at exit site

If the patient has a triple-lumen catheter, from which port should you draw blood? A. The distal port B. The middle port C. The proximal port D. The peripheral port

A. The distal port

The nurse is performing a dressing change for a central vascular access device. The nurse performs hand hygiene, applies clean gloves and a mask. The nurse removes the old dressing in the direction opposite of how the catheter was inserted, noting drainage and appearance of insertion site. The nurse inspects the catheter and hub for intactness, removes clean gloves, and performs hand hygiene. The nurse opens the dressing kit and applies clean gloves. The nurse cleans the exit site with alcohol swabs by swabbing the exit site in a horizontal plane, then a vertical plane, followed by a circular motion (from the middle outward). The nurse repeats with chlorhexidine swabs and applies a transparent dressing. The nurse labels the dressing with date, time of dressing change, and initials. The nurse disposes of soiled supplies, removes gloves, performs hand hygiene, and documents the procedure. Which of the following actions made by the nurse require correction? (Select all that apply.) A. The type of gloves worn to remove the old dressing B. The type of gloves worn to apply the new dressing C. The direction the nurse removed the old dressing D. The direction the nurse used to clean the exit site E. The information the nurse put on the label of the new dressing F. The time between swabbing the site and application of dressing

B, C, F

The student nurse is going to flush a triple-lumen central line. The student nurse prepares three 3-mL syringes with normal saline and three 3-mL syringes with heparin flush solution. Another student nurse states that this is unacceptable for flushing a CVAD. Which statement is the correct rationale for this student's objection? A. "A 3-mL syringe is unacceptable for flushing a CVAD because it fails to hold an adequate volume of solution to clear the line completely." B. "A 3-mL syringe is unacceptable for flushing a CVAD because it exerts too high a psi pressure." C. "Heparin flush solution should not be used on a CVAD because it could cause coagulation problems in the patient." D. "It is unnecessary to flush all three ports; flushing the distal port is adequate."

B. "A 3-mL syringe is unacceptable for flushing a CVAD because it exerts too high a psi pressure."

The nurse is sampling blood from a central vascular access device to be followed with a continuous IV infusion. Which step in the sequence of the procedure would require correction? A. Perform hand hygiene, apply gloves; clean injection cap with antiseptic solution and allow to dry completely. Attach 10 mL syringe and flush with 3 to 5 mL of preservative-free 0.9% normal saline. B. Remove injection cap from catheter hub. Disinfect catheter hub with antiseptic solution. Attach an empty 10-mL syringe and withdraw 4-5 mL blood from catheter for the discard sample. Remove syringe with blood and discard in trash. C. Clean hub with another antiseptic solution. Attach second syringe(s) to obtain required volume of blood needed for specimen ordered. Unclamp catheter (if necessary) to withdraw blood. Once specimens are obtained, reclamp catheter (if necessary) and remove syringe. Clean catheter hub with antiseptic solution. Insert needle of syringe containing 10 mL normal saline, release clamp, flush, and reclamp. D. Connect IV tubing to end of catheter, being sure both ends are sterile. (IV tubing should already be flushed with IV fluid.) Release clamp and regulate IV infusion as ordered. Tape all tubing connections. E. Inject blood into sampling tubes for lab. Complete lab requisitions and label specimen. Send to lab in biohazard bag. Dispose of soiled equipment and used supplies. Remove gloves and perform hand hygiene.

B. Remove injection cap from catheter hub. Disinfect catheter hub with antiseptic solution. Attach an empty 10-mL syringe and withdraw 4-5 mL blood from catheter for the discard sample. Remove syringe with blood and discard in trash. Correction: Must dispose of blood products in biohazard receptacle.

Choose the characteristics of a tunneled central vascular access device. (Select all that apply.) A. Inserted directly into a large vein B. Inserted through a large vein in the antecubital fossa and threaded into the tip of the superior vena cava C. Inserted through subcutaneous tissue between the clavicle and nipple, then into a large vein, and threaded into the superior vena cava D. Catheter tip lies in the larger vessels of the upper arm E. Lower risk of infection than a nontunneled CVAD F. Catheter tip lies in the superior vena cava G. Held in place with a Dacron cuff H. May be single, double, or triple lumen I. Inserted surgically with the patient in the operating room J. May be inserted by a specially trained nurse

C, E, F, G, H, I

The nurse is reviewing with a new nurse how to access an implanted venous port and obtain a blood sample for a complete blood count (CBC). Which statement, if made by the new nurse, indicates further instruction is needed? (Select all that apply.) A. "I should first cleanse the site with alcohol swabs, then chlorhexidine swabs, letting it completely dry each time." B. "I should insert the Huber needle through the skin at a 90-degree angle." C. "To obtain blood samples, I should first aspirate and discard 10 mL of fluid." D. "I should flush the port with heparin flush solution before obtaining the blood samples and flush with normal saline after." E. "I will need a pair of sterile gloves."

C. "To obtain blood samples, I should first aspirate and discard 10 mL of fluid." D. "I should flush the port with heparin flush solution before obtaining the blood samples and flush with normal saline after."

The nurse is preparing to obtain blood from a CVAD and then change the dressing. Nursing care would be correct if which syringes are used? A. 1 mL syringes B. 3 mL syringes C. 10 mL syringes D. 60 mL syringes

C. 10 mL syringes

The nurse is going to start a continuous infusion on a patient who has a central vascular access device. The nurse is unable to flush the catheter. What actions should the nurse take? (Select all that apply.) A. Attempt to infuse the fluids by gravity rather than by an IV pump. B. Administer a thrombolytic. C. Flush with a smaller syringe—e.g., a 1- or 3-mL syringe. D. Have the patient cough and deep breathe. E. Reposition the patient. F. Place the patient in the Trendelenburg's position. G. Raise the patient's arm. H. Forcefully flush the catheter. I. Attempt to aspirate and flush again; if unsuccessful, notify health care provider. J. Make sure the tubing is kink free or unclamped.

D, E, G, I, J

A student nurse is observing a staff nurse care for a CVAD. The student nurse asks why a large central vein is necessary for a CVAD. What is the best response by the nurse? A. "It is necessary to prevent the vein from collapsing when the catheter is inserted." B. "It has to be large enough for the catheter to fit." C. "The large vessel lumen is less likely to develop clot formation than a small vein." D. "The large vessel lumen minimizes the risks of vessel irritation, inflammation, or sclerosis."

D. "The large vessel lumen minimizes the risks of vessel irritation, inflammation, or sclerosis."

A patient is to begin chemotherapy and there is discussion regarding placement of a CVAD. Which statement requires correction? A. The tunneled CVAD and implanted venous port are considered permanent. B. Implanted venous ports should be flushed monthly with 3-5 mL heparin (100 units/mL) to maintain patency. C. Medications that are incompatible may be administered through different lumens of the same CVAD. D. An implanted venous port and a percutaneous CVAD require surgical placement.

D. An implanted venous port and a percutaneous CVAD require surgical placement.

How frequently should a transparent occlusive dressing be changed? A. Every 24 hours and as needed B. Every 48 hours and as needed C. Every 3 days and as needed D. Every 5-7 days and as needed

D. Every 5-7 days and as needed