Central Vascular Access Devices (CVAD) Questions and Answers(A+ Solution guide)

Choose the characteristics of a tunneled central vascular access device (CVAD) - -Inserted through subcutaneous tissue between the clavicle and nipple, then into a large vein, and threaded into the superior vena cava. -Lower risk of infection than a nontunneled CVAD. -Catheter tip lies in the superior vena cava. -Held in place with a Dacron cuff. -May be single, double, or triple lumen. -Inserted surgically with the patient in the operating room. Identify the uses of a central vascular access device. - -Administering intravenous (IV) fluids. -Obtaining blood samples. -Infusing blood products. -Providing parenteral nutrition. -Administering chemotherapy. -Infusing medications. Identify possible complications of a PICC. - -Air embolism. -Thrombosis. -Occlusion. -Sepsis. -Phlebitis. Implanted venous port. - Requires a noncoring needle to access device. PICC line. - Usually located in the antecubital fossa. Percutaneous central vascular access device. - Inserted directly through the skin into a large vein.Midline catheter. - Usually shorter than a PICC line. Tunneled central vascular access device. - Have single, double, or triple lumens. What is the primary advantage of a central vascular access device over the use of a peripheral IV? - It can remain in place longer. 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? - "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? - An implanted venous port and a percutaneous CVAD require surgical placement. The nurse is performing a dressing change for a central vascular access device (CVAD). The nurse performs hand hygiene and applies clean gloves and a mask. The nurse removes the old dressing with the nondominant hand pulling in an upward direction, 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 chlorhexidine gluconate (CHG) swabs using friction in a back-and-forth motion 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. - -The type of gloves worn to apply the new dressing. -The method the nurse used to remove the old dressing. -The time between swabbing the site and application of dressing. How frequently should a transparent semipermeable membrane dressing be changed? - Every 5 to 7 days and as needed. Rationale: A sterile gauze dressing should be changed every 2 days and as needed. A transparent semipermeable membrane (TSM) dressing may be changed every 5 to 7 days and as needed.Rationale & Interventions - The nurse should wear a mask; follow agency protocol regarding whether the patient is masked. If patient is not masked, have patient turn head in opposite direction of catheter insertion site. This prevents spread of airborne microorganisms over the vascular access site.The placement or exit site is cleaned with CHG solution by using friction in a back-and-forth motion for 30 seconds. Performing skin antisepsis reduces the incidence of catheter-related infections. Chlorhexidine must be dry to be effective in reducing microbial count. The upper-arm circumference of a peripherally inserted central catheter (PICC) line or midline catheter will provide information regarding potential thrombus formation. An arm measurement with a 3-cm increase can indicate thrombosis. The dressing should be labeled with the date, time, and initials of the person performing the procedure. This provides a means to determine when the next dressing change is due. 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? - Patient afebrile; redness and tenderness at exit site