NURB 3130 Final Exam Part I (Exam 1,2, and 4 Handout Info)
Where does a CVAD typically terminate? - correct answer - superior vena cava
- right atrium
What is used to verify placement? - correct answer x-ray
Who typically inserts CVADs? What technique is used? - correct answer - medical doctors
- specialized nurse
- physician assistant
- sterile technique
What types of patients are prescribed CVADs? - correct answer - patients with frequent blood
sampling
- rapid fluid resuscitation
- vasoactive medications
- critically ill patients
- prolonged antibiotic administration
How long can a CVAD remain in a patient? - correct answer 6 months to a year
What is the typical catheter length? - correct answer 50 to 60 cm
What type of catheter is inserted directly into the central vein? - correct answer Non- Tunneled
What type of catheter is inserted through percutaneous tissue? - correct answer Tunneled
What type of CVAD places the patients at the greatest risk of infection? - correct answer Non-
Tunneled
Non-Tunneled CVAD - correct answer - has 1-5 lumens (brown port-most distal, blue part- most
medial, white- closest)
- fast access, can be quickly inserted at the bedside, useful in emergencies
- short term use only
- blood, ABX, TPN, long-term chemo
Tunneled CVAD - correct answer - can have 1 or more lumens
- inserted into the chest
- has a synthetic cuff to anchor catheter for stability
,- less chance of infection
- placed during surgery
- frequent, long term use
- no dressing after healing
Port-a-cath (implanted port) - correct answer - comprised of a small reservoir covered by a
thick septum
- inserted into the subclavian vein, tip in the SVC
-- implanted surgically into chest wall pocket. Inserted in subclavian vein is in the SVC
-Long term use > 1 year
-Commonly used for chemotherapy
- accessed with a non-caring (huber) needle
peripherally inserted central catheter (PICC line) - correct answer - inserted in the basilic
(preferably), cephalic, brachial, or medial cubital vein of the arm
- insert early in the course of therapy (has 1-3 lumens)
- provides access for 1 week to 6 month - long term
- no BP or venipuncture in arm with PICC line
Which is more convenient PICC line or CVC? - correct answer PICC
Why? - correct answer inserted , more convenient and cosmetically appealing. Can be placed
surgically or non-surgically at bedside under ultrasound guidance. Sterile technique vital, be
extremely aware of central line associated blood stream infection (CLABSI)
Disadvantages: PICC Lines - correct answer Risk of infection
Contraindications: PICC Lines - correct answer - skin infections/burns on that sides
- end stage renal failure
- prior mastectomy on that particular side
- use of crutches
All CVADs - correct answer IV catheter located in a central venous vessel (often subclavian or
femoral) with distal tip at SVC just above right atrium
Indications: All CVADs - correct answer intermittent or continuous use
What type of procedure is used to place all CVADS? - correct answer sterile
,Why should a x-ray be used to check placement prior to using a CVAD? - correct answer to
lower the risk of pneumothorax
S/S: All CVADs - correct answer - shortness of breath
- chest pain
- cough
- hypotension
- tachycardia
- anxiety
Flushing Ports - correct answer - Aspirate blood return to check for placement
- Flush ports with 10cc NS every shift or per policy whether in use or not - sludge, drug residue
- Flush before and after medication administration
- Flush with heparin per policy
Blood Sampling - correct answer - follow hospital policy
- Stop infusion for at least 1 minute prior to drawing a sample. flush with 10 ml normal saline. if
TPN if infusing flush with 20 mL normal saline
- using 10 mL syringe withdraw 10 ml blood...discard
- connect new 10 ml syringe and withdraw amount of blood needed for ordered test
- flush catheter port with 10 ml normal saline using pulsating technique
When should you obtain a blood culture from a CVAD? - correct answer when you suspect to
be the source of infection
Medication Adminstration - correct answer - Attach 10ml syringe, saline flush syringe
- Open clamp
- Aspirate or blood return
- Flush with saline
- Attach medication syringe (diluted) Administer medication at appropriate rate
- Disconnect medication syringe and attach saline flush. IVP saline following medication
administration
- Maintain positive pressure (luer lock is secure); close clamp
, Dressing Changes - correct answer -Follow institutional policy. Usually change every 7 days
- Assess site for redness, swelling, drainage, tenderness, and condition of dressing (wet, loose,
soiled)
-Both nurse and patient wears mask, nurse wears bonnet. Use clean gloves to remove old
dressing
- Don sterile gloves, follow directions on aseptic site cleaning solution. Measure catheter
length. Apply chloroprene- blue sky to insertion site, apply occlusive dressing
-- remove PPE. Document findings.
Steps to Discontinue a non-tunneled CVAD - correct answer - Follow hospital policy
- May require credentials/training to discontinue
- Catheter equipment: sterile suture removal kit, occlusive dressing, 4x4 gauze pads, tape, clean
gloves, measuring tape
- Position in supine, lying down with insertion site BELOW the level of the heart...Never sitting
- Perform hand hygiene and don gloves
- Remove old dressing and sutures
- Ask patient to perform Valsalva Maneuver
- immediately apply occlusive dressing
- document assessment and findings
Why should you gently pull the catheter out while the patient is bearing down? - correct
answer prevents the entrance of air
Why should you inspect the catheter tip after removal? - correct answer - to measure the
catheter and compare the measure to the length documented at insertion
CLABSI - correct answer central line associated blood stream infection
What is the most likely site of a CLABSI? - correct answer femoral vein
Prevention: CLABSI - correct answer -Strict handwashing
-Use procedural checklist
-Maximal sterile barrier
-Follow antiseptic instruction precisely
-Cover connectors
Where does a CVAD typically terminate? - correct answer - superior vena cava
- right atrium
What is used to verify placement? - correct answer x-ray
Who typically inserts CVADs? What technique is used? - correct answer - medical doctors
- specialized nurse
- physician assistant
- sterile technique
What types of patients are prescribed CVADs? - correct answer - patients with frequent blood
sampling
- rapid fluid resuscitation
- vasoactive medications
- critically ill patients
- prolonged antibiotic administration
How long can a CVAD remain in a patient? - correct answer 6 months to a year
What is the typical catheter length? - correct answer 50 to 60 cm
What type of catheter is inserted directly into the central vein? - correct answer Non- Tunneled
What type of catheter is inserted through percutaneous tissue? - correct answer Tunneled
What type of CVAD places the patients at the greatest risk of infection? - correct answer Non-
Tunneled
Non-Tunneled CVAD - correct answer - has 1-5 lumens (brown port-most distal, blue part- most
medial, white- closest)
- fast access, can be quickly inserted at the bedside, useful in emergencies
- short term use only
- blood, ABX, TPN, long-term chemo
Tunneled CVAD - correct answer - can have 1 or more lumens
- inserted into the chest
- has a synthetic cuff to anchor catheter for stability
,- less chance of infection
- placed during surgery
- frequent, long term use
- no dressing after healing
Port-a-cath (implanted port) - correct answer - comprised of a small reservoir covered by a
thick septum
- inserted into the subclavian vein, tip in the SVC
-- implanted surgically into chest wall pocket. Inserted in subclavian vein is in the SVC
-Long term use > 1 year
-Commonly used for chemotherapy
- accessed with a non-caring (huber) needle
peripherally inserted central catheter (PICC line) - correct answer - inserted in the basilic
(preferably), cephalic, brachial, or medial cubital vein of the arm
- insert early in the course of therapy (has 1-3 lumens)
- provides access for 1 week to 6 month - long term
- no BP or venipuncture in arm with PICC line
Which is more convenient PICC line or CVC? - correct answer PICC
Why? - correct answer inserted , more convenient and cosmetically appealing. Can be placed
surgically or non-surgically at bedside under ultrasound guidance. Sterile technique vital, be
extremely aware of central line associated blood stream infection (CLABSI)
Disadvantages: PICC Lines - correct answer Risk of infection
Contraindications: PICC Lines - correct answer - skin infections/burns on that sides
- end stage renal failure
- prior mastectomy on that particular side
- use of crutches
All CVADs - correct answer IV catheter located in a central venous vessel (often subclavian or
femoral) with distal tip at SVC just above right atrium
Indications: All CVADs - correct answer intermittent or continuous use
What type of procedure is used to place all CVADS? - correct answer sterile
,Why should a x-ray be used to check placement prior to using a CVAD? - correct answer to
lower the risk of pneumothorax
S/S: All CVADs - correct answer - shortness of breath
- chest pain
- cough
- hypotension
- tachycardia
- anxiety
Flushing Ports - correct answer - Aspirate blood return to check for placement
- Flush ports with 10cc NS every shift or per policy whether in use or not - sludge, drug residue
- Flush before and after medication administration
- Flush with heparin per policy
Blood Sampling - correct answer - follow hospital policy
- Stop infusion for at least 1 minute prior to drawing a sample. flush with 10 ml normal saline. if
TPN if infusing flush with 20 mL normal saline
- using 10 mL syringe withdraw 10 ml blood...discard
- connect new 10 ml syringe and withdraw amount of blood needed for ordered test
- flush catheter port with 10 ml normal saline using pulsating technique
When should you obtain a blood culture from a CVAD? - correct answer when you suspect to
be the source of infection
Medication Adminstration - correct answer - Attach 10ml syringe, saline flush syringe
- Open clamp
- Aspirate or blood return
- Flush with saline
- Attach medication syringe (diluted) Administer medication at appropriate rate
- Disconnect medication syringe and attach saline flush. IVP saline following medication
administration
- Maintain positive pressure (luer lock is secure); close clamp
, Dressing Changes - correct answer -Follow institutional policy. Usually change every 7 days
- Assess site for redness, swelling, drainage, tenderness, and condition of dressing (wet, loose,
soiled)
-Both nurse and patient wears mask, nurse wears bonnet. Use clean gloves to remove old
dressing
- Don sterile gloves, follow directions on aseptic site cleaning solution. Measure catheter
length. Apply chloroprene- blue sky to insertion site, apply occlusive dressing
-- remove PPE. Document findings.
Steps to Discontinue a non-tunneled CVAD - correct answer - Follow hospital policy
- May require credentials/training to discontinue
- Catheter equipment: sterile suture removal kit, occlusive dressing, 4x4 gauze pads, tape, clean
gloves, measuring tape
- Position in supine, lying down with insertion site BELOW the level of the heart...Never sitting
- Perform hand hygiene and don gloves
- Remove old dressing and sutures
- Ask patient to perform Valsalva Maneuver
- immediately apply occlusive dressing
- document assessment and findings
Why should you gently pull the catheter out while the patient is bearing down? - correct
answer prevents the entrance of air
Why should you inspect the catheter tip after removal? - correct answer - to measure the
catheter and compare the measure to the length documented at insertion
CLABSI - correct answer central line associated blood stream infection
What is the most likely site of a CLABSI? - correct answer femoral vein
Prevention: CLABSI - correct answer -Strict handwashing
-Use procedural checklist
-Maximal sterile barrier
-Follow antiseptic instruction precisely
-Cover connectors
