Central Lines and Flushes

Question 1

What kind of flushes can be used in peripheral IVs?

Answer 1

saline only

Question 2

Where are peripheral IVs inserted and where are Central Venous Catheters inserted?

Answer 2

Peripheral IV: small peripheral veins
Central Venous Catheter: large central vein

Question 3

Why inserts Central Venous Catheters?

Answer 3

specially trained staff and surgeons

Question 4

Where does a central venous catheter line end?

Answer 4

Near the superior vena cava

Question 5

When would you use a clean dressing change vs a sterile dressing change for IVs?

Answer 5

clean: peripheral IVs
sterile: central venous catheter

Question 6

Why is a femoral central line not ideal?

Answer 6

higher risk of infection (through voiding)

Question 7

What does PICC stand for?

Answer 7

peripherally inserted central catheter

Question 8

Types of CVCs

Answer 8

PICC, Tunneled, Non-tunneled, Implanted Port

Question 9

Which veins can a CVC be placed into?

Answer 9

internal jugular (preferred site), subclavian, femoral (least favorable)

Question 10

Why would a CVC be placed?

Answer 10

long term use for IV fluids, medication (antibiotics, chemotherapy), frequent blood draws, and nutrition (total parenteral nutrition)

Question 11

How is placement of a CVC verified?

Answer 11

ultrasound may be used or radiology will verify the placement

Question 12

How long are tunneled catheters placed for?

Answer 12

months to years

Question 13

How is a tunneled CVC placed?

Answer 13

IV CVC enters the skin in one place and the vein in another

Question 14

What is usually present on the catheter just under the skin on a tunneled CVC in order to prevent infection?

Answer 14

a cuff

Question 15

How is a tunneled catheter secured?

Answer 15

with sutures

Question 16

Three types of tunneled catheters

Answer 16

Hickman, Groshong, Broviac

Question 17

Why are CVCs flushed with either heparin or saline when not in use?

Answer 17

to maintain patency

Question 18

Before the use of a CVC, what type of flush should be done?

Answer 18

saline only

Question 19

What is used to routine flush CVCs when not in use?

Answer 19

typically saline followed by heparin

Question 20

How often does CVC dressing need to be changed?

Answer 20

every 5-7 days

Question 21

What does the frequency of a CVC dressing change depend on?

Answer 21

hospital policy, type of dressing, and integrity of dressing

Question 22

What does CLABSI stand for?

Answer 22

Central line associated bloodstream infection

Question 23

What are the potential complications of all CVCs?

Answer 23

Infection, Air embolism, Thrombosis, Fibrin Sheath

Question 24

Who can place a PICC line?

Answer 24

specially trained nurses, physicians, or interventional radiologists

Question 25

Where are PICC lines placed?

Answer 25

on arm or umbilicus (for infants)

Question 26

How are PICC lines placed?

Answer 26

can be placed with local anesthesia only, but sedation is used for children

Question 27

Who can a PICC line be placed on? For how long?

Answer 27

infants to adults for days, weeks, or months

Question 28

When does an implanted port get placed?

Answer 28

In the OR

Question 29

How long can implanted ports be used?

Answer 29

2+ years

Question 30

How often does an implanted port require access with saline followed by heparin flush?

Answer 30

monthly

Question 31

How is an implanted port accessed?

Answer 31

non-coring (huber) needle

Question 32

Where are Broviac, Hickman, Hohn, and Groshong CVCs placed?

Answer 32

generally on chest, but can be placed on legs of infants or for people that have had a history of multiple line placements

Question 33

Where are implanted ports usually placed?

Answer 33

on the chest

Question 34

Where are green curos caps and tips placed?

Answer 34

the needless adaptor of central line lumens not in active use, CVC IV tubing side ports, placed on peripheral access as well when IV tubing is temporarily disconnected

Question 35

How often should a PIV be flushed with saline?

Answer 35

1-2 times a shift when saline is not in use

Question 36

If a PIV is not in use, what is important to do?

Answer 36

clamp the line

Question 37

When would a NS flush be done on CVCs?

Answer 37

before starting continuous IV infusion, before and after intermittent IV medications, to cap when ending continuous infusion, twice daily to maintain patency when not in use

Question 38

How long should a hub be scrubbed?

Answer 38

15 seconds

Question 39

Why is it important to always use a 10 mL syringe on a CVC flush?

Answer 39

A smaller syringe will create too much pressure and the line may rupture

Question 40

What method is used to clear the line of a CVC when doing a saline flush?

Answer 40

pump (pulsatile) or stop/go method

Question 41

Why is the Stop/go method the best method to use when flushing CVC lines?

Answer 41

it creates the best turbulence for clearing the line

Question 42

Should heparin be used on a CVC line when there is continuous infusion of medication?

Answer 42

no

Question 43

Heparin flush concentration for children >12 months and adults vs concentration for children <12 months

Answer 43

100:1 vs 10:1

Question 44

Should an implanted port or a CVC (i.e. Broviac, Hickman, PICC) receive a higher heparin solution flush?

Answer 44

implanted port (5 mL vs 3 mL)