NURSING 317 EXAM III QUESTIONS
WITH COMPLETE SOLUTION
jvenous access device - inserted into large central vein usually jugular or subclavian and fed into superior
vena cava
Types of PICC - cephalic, basilica, brachial
Purposes of VAD - irritating meds, chemo, TPN and lipids, lack of peripheral veins, LT antibiotics or iv
therapy, self-administration
size of syringe CVAD meds come in - 10 mL***
types of VAD - central line, SQ implanted ports, PICC
Non tunneled central line - temporary line put in jugular or subclavian by MD at bedside with consent,
aseptic technique, trendelenberg position, sutured in place and has isotonic solution
Triple lumen on central line - distal: brown
Medial: blue
Proximal: white
flush when not in use
Tunneled aka Hickman/Broviac - inserted during surgery for LT use with triple or double lumen that is
tunneled through SQ tissue with tip inserted into central vein. Dacron cuff used and is flushed when not
in use
Dacron Cuff - stabilizes and establishes scar formation and prevent infection in tunneled central lines
Hickman Central line - has two ports, available in larger french size, more commonly used in adults
Brovaic central line - available in single lumen, smaller french size, common in peds and geriatric
Groshong Central lIne - alternative to Hickman and Broviac, inserted during surgery, LT use, no need to
flush with heparin, 3 way valve reduces embolism and clots, more accurate tip placement
advantages for Groshong - more cost effective, decrease risk of bleeding and emboli, elimination of
heparin flush and catheter clamping, reduces flushing needs
SQ implanted: portacath - inserted in surgery for LT use in upper arm or chest, placed under skin and
accessed with needle, minimal maintenance and can remain from months to years, flush with heparin
PICC - inserted by trained nurse just above antecubital fossa and advanced to superior vena cava, can
keep up to months
, Typical uses for PICC - short term IV therapy, frequent administration of blood products, blood draws,
drug infusion
Pressure Activated safety valve - end valve activated to open by pressure like flush or aspiration, valve
usually closed which prevents blood from entering, flush only requires saline, flushed between meds and
once a week
advantages of picc - decrease risk associated with neck, chest insertion, cost and time effective,
decreases discomfort, appropriate for at home, reliable
Maintaining PICC - monitor for subclavian thrombosis, measure arm circumference beginning at client
arm and up ten inches, measure insertion site and if in upper arm from insertion to shoulder and
circumference at half point, statlock devices
Complications of CVAD - central line clot, bleeding, catheter migration, bleeding, thrombosis, air
embolism, infection
Local s/s for CVAD - erythema, tenderness, exudate at catheter site
systemic s/s for CVAD - fever, chills, N, V, malaise
Nursing requirements for CVAD - maintain patency, flushing, changing caps, drawing blood, monitor for
infection, removal of central line and PICC
maintaining CVAD - flushing per protocol, SASH method
SASH method - saline, medication, saline, heparin
flushing PICC - SASH method, positive pressure when applying heparin, if line clots use urokinase, TPA to
declot
PICC removal - supine position, arm 45-90 degrees, slowly pull out with hand over hand technique and
examine site. apply pressure after PICC removed, small sterile dressing over site, measure and examine
picc, document
difficulty with picc removal - if resistance, do not force line out, apply compress for 20 mins then
reattempt, check for mass above insertion site or catheter accordion down vein
if picc breaks - typically breaks at hub, grab onto line out of skin and pull out
if picc migrates to vessel or is shorter than initial insertion place tourniquet or BP cuff 2-3 inches over
site and call MD
VAD dressing change - sterile procedure, every 72 hours of if soiled or loose, mask!, supplies in kit
PICC dressing change times - 24 hours then 72 then 7 days
changing access cap - cap policy, 72 hours to 7 days, supine position, remove cap with aseptic technique,
new cap out of package sterile and place on hub, cleanse cap with antimicrobial swab
WITH COMPLETE SOLUTION
jvenous access device - inserted into large central vein usually jugular or subclavian and fed into superior
vena cava
Types of PICC - cephalic, basilica, brachial
Purposes of VAD - irritating meds, chemo, TPN and lipids, lack of peripheral veins, LT antibiotics or iv
therapy, self-administration
size of syringe CVAD meds come in - 10 mL***
types of VAD - central line, SQ implanted ports, PICC
Non tunneled central line - temporary line put in jugular or subclavian by MD at bedside with consent,
aseptic technique, trendelenberg position, sutured in place and has isotonic solution
Triple lumen on central line - distal: brown
Medial: blue
Proximal: white
flush when not in use
Tunneled aka Hickman/Broviac - inserted during surgery for LT use with triple or double lumen that is
tunneled through SQ tissue with tip inserted into central vein. Dacron cuff used and is flushed when not
in use
Dacron Cuff - stabilizes and establishes scar formation and prevent infection in tunneled central lines
Hickman Central line - has two ports, available in larger french size, more commonly used in adults
Brovaic central line - available in single lumen, smaller french size, common in peds and geriatric
Groshong Central lIne - alternative to Hickman and Broviac, inserted during surgery, LT use, no need to
flush with heparin, 3 way valve reduces embolism and clots, more accurate tip placement
advantages for Groshong - more cost effective, decrease risk of bleeding and emboli, elimination of
heparin flush and catheter clamping, reduces flushing needs
SQ implanted: portacath - inserted in surgery for LT use in upper arm or chest, placed under skin and
accessed with needle, minimal maintenance and can remain from months to years, flush with heparin
PICC - inserted by trained nurse just above antecubital fossa and advanced to superior vena cava, can
keep up to months
, Typical uses for PICC - short term IV therapy, frequent administration of blood products, blood draws,
drug infusion
Pressure Activated safety valve - end valve activated to open by pressure like flush or aspiration, valve
usually closed which prevents blood from entering, flush only requires saline, flushed between meds and
once a week
advantages of picc - decrease risk associated with neck, chest insertion, cost and time effective,
decreases discomfort, appropriate for at home, reliable
Maintaining PICC - monitor for subclavian thrombosis, measure arm circumference beginning at client
arm and up ten inches, measure insertion site and if in upper arm from insertion to shoulder and
circumference at half point, statlock devices
Complications of CVAD - central line clot, bleeding, catheter migration, bleeding, thrombosis, air
embolism, infection
Local s/s for CVAD - erythema, tenderness, exudate at catheter site
systemic s/s for CVAD - fever, chills, N, V, malaise
Nursing requirements for CVAD - maintain patency, flushing, changing caps, drawing blood, monitor for
infection, removal of central line and PICC
maintaining CVAD - flushing per protocol, SASH method
SASH method - saline, medication, saline, heparin
flushing PICC - SASH method, positive pressure when applying heparin, if line clots use urokinase, TPA to
declot
PICC removal - supine position, arm 45-90 degrees, slowly pull out with hand over hand technique and
examine site. apply pressure after PICC removed, small sterile dressing over site, measure and examine
picc, document
difficulty with picc removal - if resistance, do not force line out, apply compress for 20 mins then
reattempt, check for mass above insertion site or catheter accordion down vein
if picc breaks - typically breaks at hub, grab onto line out of skin and pull out
if picc migrates to vessel or is shorter than initial insertion place tourniquet or BP cuff 2-3 inches over
site and call MD
VAD dressing change - sterile procedure, every 72 hours of if soiled or loose, mask!, supplies in kit
PICC dressing change times - 24 hours then 72 then 7 days
changing access cap - cap policy, 72 hours to 7 days, supine position, remove cap with aseptic technique,
new cap out of package sterile and place on hub, cleanse cap with antimicrobial swab
