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Comprehensive Vascular Access Board Certified Study
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How long does it take the exit site of a tunneled cath to heal?
2-3 weeks
How is the port secured inside the patient?
Port is sutured into a subcutaneous pocket under the skin
IO sites
Proximal humerus, sternum, iliac crest, femur, or tibia
You go to flush a freshly inserted IO and your patient screams in pain. What do you do?
Administer analgesic through line. The first flush is often very painful
Time frame for umbilical access
up to 4days of life
What is an antiseptic?
Chemical agent that inhibits microorganisms on skin or tissue to limit or prevent infection
What factors may affect the activity and effectiveness of an antiseptic solution?
Organisms concentration in that area, organisms composition, concentration of the antimicrobial
agent, if the antimicrobial agent is combined with any other antiseptic agents, duration of the
organisms exposure to the antimicrobial agent
What are iodophors?
Solutions of iodine in complexes that contain a low amount of free iodine
What makes up betadine?
,Solution that contains up to 10% of an iodine complex, and provides up to 1% free iodine for
skin antisepsis
What are iodophors effective against?
G+, G-, fungi, and viruses. But minimal against bacterial spores
What must happen for an iodophor to be effective?
Contact with the skin for at least 2 minutes to release the free iodine
How long are the residual effects of iodine?
2hrs
What contains 1-2% iodine in an alcohol base?
Tincture of iodine
What population shouldn't have an iodine prep?
Neonates and infants due to percutaneous absorption that can cause hypothyroidism in newborns
How does alcohol work as an antimicrobial?
Denatures the cell proteins and dissolves the cell lipids
Type of organisms that alcohol has a good effect on
G+, G-, fungus, virus
Disinfectant works against what
G+, G-, virus, and fungi on hard, non-porous surfaces
What type of CVAD is recommended for patients with acute leukemia and other cancers?
Tunneled CVL or Port
What VAD is recommended for infants and toddlers receiving TPN?
Tunneled CVL
Apheresis flow rates
Dialysis flow rates
90-120mL/min
350-400mL/min
Device selection for aquapheresis
Dual lumen, large bore catheter
,Congenital heart diseases that increase the risk for occluded vessels
Glenn or Fontan anastomoses
What is the best VAD in cases of sepsis or bacteremia?
PIV
Landmark based measurements have what % failure rate?
30%
How do you measure for a PICC in the scalp?
Insertion site, along the jugular, right clavicular head, 3rd intercostal space
How do you measure for PICC in the lower extremities?
insertion site, up leg to umbilicus, up to Xyphoid process
Veins transport _____ from tissues to the right side of the heart
deoxygenated
Pulmonary vein transports ____ blood to the left side of the heart
oxygenated
Pulmonary artery transports ____ blood to the pulmonary capillary bed to do what?
unoxygenated; for CO2 and O2 gas exchange
Why would the IJ be preferred over the SVC?
IJ is direct root to brachiocephalic vein and it avoids the pinch off that can happen with the
subclavian
Vessel that forms from the confluence of the iliac veins located below the diaphragm
IVC
Medial nerve effects which part of hand?
Palm, thumb, pointer finger
Ulnar nerve effects which part of hand?
pinky, ring finger
PICOT
Patient population
Intervention
, Comparison
Outcome
Time
0-18mos
Trust vs. Mistrust
Fear of strangers and separation anxiety
18mos-3yrs
Autonomy vs. Shame
Egocentric
3-5yrs
Initiative vs. guilt
Fear of injury, loss of control, and being alone
Follows directions but short attention span
Praise for cooperation
6-12yrs
Industry vs inferiority
Fear of injury, loss of control, and disappointing important people
Offer choices and more detailed explanations
13-18yrs
Identity vs. role conflict
Capable of abstract thinking, more responsibility for decisions
Include in discussions
Offer honest/open explanations
Equipment used for infusion therapy is regulated by who?
FDA and Center for Devices and Radiologic Health (CDRA)
Minimal catheter size for apheresis in adults
11.5Fr
PICCs not appropriate due to small catheter size
Name of technique we use for PIVs
Modified Seldinger Technique
Slides catheter over the needle and into the vessel
40% of patients who exhibit signs of pinch-off syndrome will experience ...