AVA CERTIFICATION EXAM: VASCULAR ACCESS DEVICES

AVA CERTIFICATION EXAM: VASCULAR ACCESS DEVICES In the presence of a newly placed automatic intracardiac defibrillator or pacemaker - Avoid PICC insertion on ipsilateral side for six months CVAD insertion in the presents of an IVC filter - Can Inadvertently trap wires in the filter PIV is indicated for adequate venous availability for indicated therapy. This includes - Non- vesicants and non- irritants with a pH 5 to 9 and osmolality <600 mOSm/L PICCS can be utilized for - Chemotherapy, TPN, IV solutions and medication, blood products, plasmapheresis, hemodialysis, diagnosing, frequent blood sampling. Power Injectable devices are made of polyurethane and withstand high pressure of >300 pounds per square inch to be used during - CT or MRI scan Tunneled CVAD may be indicated for infants and toddlers receiving - TPN Axillary lymph node dissection including sentinel node biopsy, requires special considerations with vascular access placements - Use contralateral arm for PIV or PICC placement. In morbid obesity the most appropriate vein selection may be - The cephalic vein. Ultrasound appearance of a target vein that changes in size from large to small and back again as you move up the arm - May represent venous dilatation from a distal stenosis or occlusion How does one measure for PICC placement? - Position arm at 90 degree angle. Measure from planned insertion site to the right Clavicular head, Then down to the third intracoastal space. Land-marked measuring techniques have reported failure and complications as high as - 30 percent and 18.8 percent respectively Catheter-related infections most often result from - -contamination of the central venous catheter -contamination of the insertion site -break in sterile technique during insertion Maximum sterile barrier protection may reduce the incidence of - Catheter contamination and CLABSI Chlorhexidine with alcohol is superior to - Povidone/iodine or isopropyl alcohol How should Chlorhexidine be applied? - Friction on clean skin for 30 seconds, then allow to dry completely. How should Chlorhexidine or appropriate skin antiseptic be applied to the femoral area? - Should be applied for at least two minutes using friction, then allow to dry. Use 10 ml syringe - To minimize pressure on the catheter Lock solutions include - Normal Saline, or Heparinized saline 10 to 1000 units per milliliter Preferred skin antiseptic for site care. - 0.5% Chlorhexidine preparation with alcohol Allow chlorhexidine to dry completely before applying - Securement device or transparent dressing Catheter removal. Place patient in what position? - Supine or slight Trendelenburg position If patient inhales during catheter removal what could occur? - Air embolism After removing the catheter apply what to site? - Antiseptic ointment Occlusive dressing should remain in place how long after catheter is removed - 24 hours Assessment of PICC. - Observe insertion site and affected arm for signs and symptoms of potential problems every 8 hours. Exit site bleeding. Exit site infection. Catheter related sepsis with temperature greater than 101 degrees. External catheter leakage. Catheter tip malposition - May complain of gurgling noise, ear, and neck pain during infusion, catheter embolus or rupture of catheter. PICC CATHETER Phlebitis pain, redness, swelling, can appear - anywhere along the cannulated vein. GROSHONG CATHETER ADVANTAGES