Central Venous Catheter Care

Question 1

4 reasons a patient may need a CVC

Answer 1

TPN, chemotherapy, longterm antibiotic use, loss of peripheral access

Question 2

What determines whether a line is peripheral or central?

Answer 2

the location of the tip of the catheter (NOT the insertion site)

Question 3

Veins used for non-tunneled CVC (“deep lines”)

Answer 3

Subclavian (SC), internal jugular (IJ)

Question 4

3 Types of tunneled CVCs

Answer 4

Hickman, Groshong, and Broviac

Question 5

Two other names for implanted ports

Answer 5

“Portacaths” and “PowerPorts”

Question 6

Location of tip of peripherally-inserted central catheter

Answer 6

Right atrium or superior vena cava

Question 7

A primary bloodstream infection that develops in a patient with a central line in place within the 48-hr period before the onset of blood stream infection that is not r/t an infection from another site is called a

Answer 7

Central Line-Associated Blood Stream Infection (CLABSI)

Question 8

TRUE or FALSE: The RN may run 3 incompatible drugs through a triple lumen deep line.

Answer 8

TRUE

Question 9

What is a risk of placing deep line in subclavian

Answer 9

pneumothorax

Question 10

The ____________ prevents atmospheric air from entering the large vessel during the removal of a non-tunneled CVC.

Answer 10

Valsalva Maneuver

Question 11

Advantage of a tunneled CVC compared to imported plant

Answer 11

No needle sticks required

Question 12

Disadvantage of a tunneled CVC

Answer 12

Prolonged break in skin integrity

Question 13

Who removes a tunneled CVC?

Answer 13

the HCP

Question 14

The needle used to access an implanted port is called

Answer 14

a non-coring (‘Huber’) needle

Question 15

Primary complication of implanted port

Answer 15

Catheter occlusion

Question 16

2 Advantages of PICC

Answer 16

Less microorganisms on arm

Less insertion complications such as pneumothorax

Question 17

True or False: The RN may remove a PICC?

Answer 17

TRUE

Question 18

Describe how the RN will remove a PICC.

Answer 18

Have patient lie or sit down/hold hand below level of heart & bear down while withdrawing - withdraw inch-by-inch, relaxing catheter after each inch; do NOT pull catheter if vein spasms; measure length of catheter.

Question 19

How often must the access needle be changed for an implanted port with continuous IV fluids?

Answer 19

Weekly

Question 20

non-tunneled/deep lines

_____________ CVC
- Could accidentally nick lung and cause pneumothorax
- Less movement issues
________________CVC
- Nuisance bc of placement on neck – neck is very mobile and moist
- No risk of lung puncture

Answer 20

• Subclavian CVC
• Could accidentally nick lung and cause pneumothorax
• Less movement issues
• Internal jugular CVC
• Nuisance bc of placement on neck – neck is very mobile and moist
• No risk of lung puncture

Question 21

tunneled or non-tunneled

• Inserted by HCP, Removed by RN
• 1-5 ports
• 7-10 inches long
• Tip is in superior vena cava (enters through _______ or _______)
• CXR post procedure – bc of risk of pneumothorax
• No recommended dwell time
• Short term use – emergency, trauma, critical care, surgery
• Not for home/ambulatory clinic setting

Answer 21

non-tunneled
enters through subclavian or internal jugular vein)

Question 22

non-tunneled or tunneled

-Complications:
- Bleeding at site
- Air embolus
- Pneumothorax
-Dressing includes:
- The stat lock is there to stabilize so skin hole doesn’t get bigger and allow bacteria to get in easier
- The algidex/bio patch is there to prevent CLABSI

Answer 22

nontunneled IJ and SC

Question 23

non-tunneled or tunneled

-Removed by RN
- Check INR if on anticoags (International Normalized Ratio - test used to measure the clotting time of blood. It is primarily used to monitor patients who are taking blood thinners, such as warfarin, to prevent blood clots.) – to make sure they wont have bleeding issues when removed
- Supplies:
- Sterile suture removal kit
- Sterile and clean gloves
- Occlusive dressing
- Measuring tape – make sure as much came out as went in, length of catheter is documented in chart

-Explain procedure:
- Supine or Trendelenburg
- Valsalva – hum or bear down, prevents atmospheric air from being sucked into the big vessel when CVC is being pulled out
- Apply pressure for 3-5 mins
- Apply occlusive dressing
- May need to culture tip of catheter

Answer 23

nontunneled

Question 24

tunneled vs nontunneled

• Provides more stability, less movement = less likely to get pulled out
• Placed in OR, removed by HCP
• Trade names – named after physician who invented them
• Broviac, hickman, groshong
• Used when infusion therapy is frequent and prolonged (even years)
• Adv - Doesn’t require needle sticks (implanted ports do)
• Disadv – prolonged break in skin integrity (implanted ports do not)
• Irrigation protocol varies – may require heparin
• Site care required

-Complications
- Catheter damage
- Occlusion
- Thrombosis
- Sepsis

Answer 24

tunneled

Question 25

which CVC - No tubing involved – least impact on body image - Requires huber needle to access port - Chest port wears out after 2000 punctures - Upper arm port wears out after 750 punctures - Placement in OR, Surgically implanted – catheter attached to a port which is placed in a pocket made in SQ tissue on chest wall - Post procedure – incision is closed - For pts that require IV therapy > a year - Considered semi permanent - Site care – only when accessed - Change access needle weekly - Requires Cleaning and dressing - Complications – catheter occlusion - Removed by HCP – must make incision to remove port

Answer 25

implanted port

Question 26

which CVC - 8-10 inches long - Threaded up peripheral vessel into big vein - Placed at bedside by certified RN, HCP, or radiologist - Duration 3-12 mos - Placed at bend of elbow - No BP or blood draws on this arm – risk of impairing the fusion and damaging the site - Lower complication rates than CVC - Since its not going on the neck No issues with neck mobility - Less microorganisms on arm - Less insertion complications - No risk of lung puncture (pneumothorax) - Irrigation required - Site care required - removed by RN

Answer 26

PICC - non-tunneled

Question 27

which CVC -Site care required - Swabbing caps with alcohol - Dressing changed - day after insertion - every Wednesday - when soiled -removed by RN - pt lie down or sit down - hand below level of heart - bear down while withdrawing - withdraw slowly - do not pull catheter if vein spasms - measure length of catheter (cm)

Answer 27

PICC