Central Venous access Devices

Question 1

Catheter pinch-off Syndrome

Answer 1

• rare complication of tunneled central venous catheters that occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion
• When a central catheter is inserted into the subclavian vein, the clavicle and rib can move together and compress the central line catheter, causing pinch-off syndrome.
• Warning signs include difficulty drawing blood samples and resistance to the infusion of IV fluids.

Question 2

Pinch-off syndrome nursing interventions

Answer 2

Nursing interventions:
-It is imperative to obtain a brisk blood return and to be able to flush the catheter easily before infusing fluids or medications through the catheter.

-If you cannot flush the catheter or aspirate blood, ask the patient to change the position of his arm on the catheter’s side by raising it or by
pulling his shoulder backward.

• If you are able to aspirate blood and flush the catheter after the position change, suspect pinch-off syndrome.
• Be sure to assess the periclavicular area near the insertion site for redness, swelling, or crepitus (a noise or vibration you can feel).

Question 3

Basilic vein

Answer 3

-large superficial vein that arises from the ulnar side of the hand, passes up the forearm, and joins with the brachial veins to form the axillary vein

Question 4

Brachial veins

Answer 4

-veins following the course of the brachial artery and joining with the basilic vein to form the axillary vein

Question 5

Cephalic vein

Answer 5

-superficial vein that arises from the radial side of the hand and winds anteriorly to pass along the anterior border of the brachioradialis muscle, ascends along the lateral border of the biceps muscle and the pectoral border of the deltoid muscle, and finally opens into the axillary vein

Question 6

Huber needle

Answer 6

-noncoring device used to access an implanted port

Question 7

Implanted port

Answer 7

-catheter whose end is attached to a small chamber placed in a subcutaneous pocket (instead of exiting from the skin), either on the anterior chest wall or on the forearm

Question 8

Vesicant

Answer 8

-chemical that produces blisters

Question 9

SASH method-Saline, Administer, Saline, Heparin

Answer 9

-technique for administering a medication intravenously, involving first flushing with normal saline solution, injecting the medication, flushing with normal saline, then flushing with heparin solution

Question 10

Central venous catheters: central venous access devices (CVADs) or central lines:

Answer 10

• Unlike peripheral intravenous catheters typically inserted into the veins of the hand or forearm, central access devices are inserted into large veins in the central circulation.
• The tip of a central venous catheter is generally threaded into the internal or external jugular veins or into the lower third of the vena cava (superior or inferior) that leads to an area just above the right atrium.
• At the time of insertion, a chest x-ray is done to confirm
• Central lines are especially beneficial for patients who have chronic diseases and require long-term intravenous therapy.

A central line is indicated for patients who need:

• parenteral nutrition
• chemotherapy or other vesicant or irritating solutions
• blood products
• antibiotics
• IV medications or solutions (when peripheral access is limited)
• central venous pressure monitoring
• hemodialysis

Question 11

Lumen

Answer 11

-a hollow channel within a tube

Question 12

single-lumen central venous catheter

Answer 12

• A single-lumen central venous catheter is used for patients who need an infusion into a large, central vein.
• When a single-lumen catheter is in place for infusing parenteral nutrition, it cannot be used to sample blood or to transfuse blood.This is because blood cells tend to adhere to the lumen and impede the flow of the nutrition solution.

Question 13

multi-lumen catheter (MLC)

Answer 13

• increases the advantages of a single-lumen catheter.
• An MLC has separate color-coded ports to identify the different lumens.
• solutions do not mix as they travel through the catheter.
• The multiple ports allow for administration of medications, blood infusions, blood sampling, fluid replacement, and pressure monitoring.
• 3 three ports: distal lumen, middle lumen, and proximal lumen

Question 14

Ports

Answer 14

1. distal lumen: Used for the administration of blood or other viscous fluids
2. Middle lumen : Used for parenteral nutrition
3. proximal lumen: Used for the administration of medications or blood

• Blood samples can be taken from any port not being used for fluid administration.
• The first hole that sits inside the patient’s vein is the proximal port (closest to the entry and farthest from the right atrium). The next hole is the medial opening, and the next is the distal (the hole farthest from the site of entry and closest to the right atrium).

Question 15

Syringe size

Answer 15

• use only 10-mL or larger syringes and avoid excessive force when flushing the lines or administering medications. Flushing with larger syringes creates less pressure; smaller syringes create more pressure.
• When injecting fluid through a catheter, a smaller syringe generates more pressure than a larger syringe does. Therefore, to reduce the risk of catheter rupture, syringes that are 10-mL or larger in size are recommended for flushing or injecting fluid into a central venous catheter.

Question 16

Flushing

Answer 16

• Flushing with preservative-free, sterile 0.9% sodium chloride solution helps ensure and maintain patency
• When flushing a central venous access device catheter, use a pulsing (push – stop – push – stop) flush to create turbulence that helps clear blood and medications from the line
• Do not flush the catheter forcefully

Question 17

Heparin flushing

Answer 17

• Valve-tip or closed-end valve catheters such as a Groshong incorporate a valve that opens from positive or negative pressure, as is generated by flushing or aspirating. Otherwise, the valve remains closed to keep blood from entering the catheter. These types of valves require only saline flushes.
• Flushing with heparin helps ensure and maintain patency of the central venous access device.

Question 18

Clamping.

Answer 18

• If central lines are not clamped, air might enter the patient’s central circulation, causing an air embolus.
• Keep central catheters clamped when not in use. This includes the time in between syringe changes.
• A catheter with a valved or closed tip such as a Groshong does not require clamping.

Question 19

Negative displacement devices

Answer 19

• let blood flow back into the catheter’s lumen when you disconnect the syringe or administration set.
• Blood reflux can lead to occlusions
• use a positive-pressure flushing technique: Withdraw the syringe from the injection cap as you flush the last 0.5 mL of flush solution into the catheter. Or, flush all fluid into the catheter, maintain pressure on the syringe plunger, clamp the tubing between the catheter hub and the patient, then disconnect the syringe.
• When using a device with a needle-free positive fluid-displacement injection cap, do not use positive pressure flushing techniques.
• Flush these devices only with saline and do not clamp the line.