NUR 253 Test 2 Exam Questions and Answers

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1. What is a Central Venous Access Device?: It's a catheter passed through at ends u
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a vein th in the thoracic portion of the superior vena cava or right atrium of the heart.
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WE NEVER KEEP THIS IN PLACE FOR CONVENIENCE!
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2. Short Term CVADs: They are put in for a few days to several weeks.
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Used mainly for emergency access; fluid replacement or because you can't get a perip
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heral IV. The more lumens, the higher risk for infection!
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Types:
1. PICC
2. Non-tunneled catheter vb




3. PICC = peripherally inserted central catheter: SHORT TERM USE!
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Inserted into extremity. vb vb




Entry Vein of choice: Cephalic or Basilic Vein
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Enters in through either of the above veins and threaded into the superior vena cava up to the rig
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ht atrium. Single or Double Lumen Only!
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There is a Triple Lumen that can be put in, only in the unit.
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Placement confirmation: X-RAY vb vb




Complications:
Infection Phle vb




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s Occlusion
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Can feel like it gets stuck with removal, vein spasms and holds it in, can be removed after applying heat a
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nd leaving it be for 30 minutes.
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4. Percutaneous Non-Tunneled Catheter: SHORT TERM USE! vb vb vb vb vb




(Days to <6 weeks) This CVAD has the HIGHEST RISK FOR INFECTION!!
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Enters through skin by the collar bone directly into the subclavian or jugular veins.
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It is used for emergency access and CVP rea
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dings. Non-tunneled. vb




3-5 Lumens.
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Must be surgically placed!
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RAY. Complications:
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Infection!!!!
Pneumothorax - it's very close to the lung vb vb vb vb vb vb vb




5. Tunneled Central Venous Catheter: LONG TERM USE! vb vb vb vb vb vb




(Can stay for years) Used for therapy greater than 6 months.
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Surgically placed directly into the Right Atri
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um. Up to 3 Lumens Only.
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This CVAD has the LEAST RISK FOR INFECTION.
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Placement Confirmation = X- vb vb vb




Ray Complications:
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Pneumothorax
Infection (least risk though) vb vb vb




6. Subcutaneous Implanted Ports: LONG TERM USE! vb vb vb vb vb




Directly implanted underneath the skin; goes to the internal jugular vein and threads to the bottom portion of
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the superior vena cava.
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Requires a HUBER needle to access it. This is painf
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ul. Use a numbing agent prior to accessing.
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Every-time it is accessed, it can easily get infected. vb vb vb vb vb vb vb vb




In the hospital, you need an order to access it.
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At home, they must see their PCP once a week for a heparin lock and dressing change.
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7. Pneumothorax Complication: Signs & Symptoms: vb vb vb vb




Uneven chest rise vb vb




Chest pain (one of the first sivb vb vb vb vb vb




gns) SOB (first sign)vb vb vb




Adventitious breath sounds T vb vb vb




racheal deviation Hypotens vb vb




ion
8. CLABSI (confirmed laboratory bloodstream infection): Bloodstream infe
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ction that is confirmed after CVAD was in place for >2 days.
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30,100 CLABSI infections occur each year.
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9. 5 Key Components to Prevent CLABSI: #1 = WASH YOUR HANDS ALL THE TIME!
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BEFORE, DURING, & AFTER vb vb vb




#2 = Aseptic technique
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when flushing, attaching solutions, changing sterile valve, changing dressing, drawing blood
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#3 = Monitor biopatch & dres
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sing change every 7 days
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if it has gauze change every 24 -
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48 hours also change if it is soiled
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#4 = Maintain port patency
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flush per protocol; usually every 4 hours
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REMOVE WHEN NO LONGER NECESSA
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RY
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#5 = Thorough CVAD assessment
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assess twice; first with dressing on prior to changing & second with dressing ott; exit site.
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10. CVAD Cleaning techniques: Circular = use an alcohol swab to remove any dried bloo vb vb vb vb vb vb vb vb vb vb vb vb vb



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Back & Forth = use chlorhexadine; all over insertion site for NO LESS than 30 seconds and allow to dr
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y for NO LESS than 2 minutes.
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Remove dressing from DISTAL to PROXIMAL. vb vb vb vb vb




11. CVAD Flushing Protocols: At least every 4 hours or per policy protocol. vb vb vb vb vb vb vb vb vb vb vb




ALWAYS flush with 10ml syringe (avoids pressure build
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-
up) Use the turbulent flush method (push 2ml, stop, re
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peat)

If you flush and it does not easily flush or no blood return, STOP what you are doing and check it out.
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THE ONLY WAY TO ENSURE PATENCY IS TO HAVE BLOOD RETURN AND EASY FLUSHING.
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12. CVAD Blood Draws: 1. Clean first! vb vb vb vb vb




2. Aspirate for blood return (then clean hub) vb vb vb vb vb vb




3. Flush with NS (then clean hub) vb vb vb vb vb




4. Waste first 5 - 10 m of blood (then clean hub) vb vb vb vb vb vb vb vb vb vb




5. Collect sample (then clean hub) vb vb vb vb




6. Flush again with NS (then clean hub) vb vb vb vb vb vb




7. If Heparin locked, re-instill new heparin (then clean hub)
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MUST ALWAYS ASPIRATE FOR BLOOD RETURN PRIOR TO BLOOD DRAWS OR ADMINISTERING MEDS!
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13. Administering IV meds vb vb




: IV Push: Make sure you clean first!
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Aspirate for blood retur vb vb vb




n. Flush with NS.
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Inject med (make sure you know the timing)
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