Central Venous Catheters

Question 1

Where do most central lines terminate?

Answer 1

Superior vena cava

Question 2

What should be monitored once a central line is placed?

Answer 2

arrhythmias, infection, pain

Question 3

Where are early signs of central line infections seen?

Answer 3

at the site

Question 4

What are two reasons that patients need a central line put in?

Answer 4

poor peripheral venous access or for long-term IV therapeutics

Question 5

What are examples of reasons that a patient may have a central line for long-term IV therapy?

Answer 5

high volume fluid administration, medication administration (electrolyte replacement, anti-invectives, chemotherapy), blood transfusions, vasopressors, TPN, plasmapheresis/dialysis

Question 6

Where is a tunneled CVC placed? Non-tunneled?

Answer 6

OR vs bedside

Question 7

what is the most common CVC that is placed?

Answer 7

triple lumen catheter: 7 french

Question 8

What are examples of non-tunneled CVCs?

Answer 8

PICC, IJ, Subclavian, Vascath

Question 9

What is an example of an implanted CVC?

Answer 9

Port-a-cath (PAC)

Question 10

What are examples of tunneled CVCs?

Answer 10

Hickman, Broviac, PICC, Subclavian, Permcath

Question 11

How can CVCs be assessed for patency?

Answer 11

Saline flush and blood return

Question 12

What can PIVs be used for?

Answer 12

high flow IV fluids, blood products, IV push drugs, and electrolyte replacement

Question 13

How is a non-tunneled IJ kept in place?

Answer 13

sutured

Question 14

How are PICC lines anchored?

Answer 14

stitches or StatLock

Question 15

How are PICC lines flushed?

Answer 15

10mL saline flush

Question 16

How are PICC lines advanced?

Answer 16

with a guide wire

Question 17

Before using a CVC, what is important to check?

Answer 17

Chest x-ray has confirmed placement and there is an order by the doctor

Question 18

What is the biggest complications for CVCs?

Answer 18

DVT

Question 19

What is a daily assessment for a PICC line in order to ensure a DVT hasn’t formed?

Answer 19

upper arm circumference

Question 20

When is a femoral catheter used?

Answer 20

In trauma situations and immobile patients

Question 21

Why do you not need x-ray confirmation to ensure placement of a femoral catheter?

Answer 21

It terminates at the inferior vena cava

Question 22

What color are the catheters for dialysis?

Answer 22

red and blue

Question 23

What kind of needles need to be used for an implanted port-a-cath?

Answer 23

non-coring needles (huber)

Question 24

When are port-a-caths most often used?

Answer 24

for cancer patients

Question 25

What would a power port be used for?

Answer 25

Rapid injection or CT/MRI with contrast

Question 26

What is important to place on a central line for infection prevention?

Answer 26

biopatch

Question 27

How are tunneled central lines anchored?

Answer 27

1-2 cuffs

Question 28

Who inserts a tunneled central lines?

Answer 28

interventional radiology or operating room

Question 29

What is a two lumen red and blue line with 1-2 cuffs called?

Answer 29

hickman line (tunneled)

Question 30

What is the purpose of cuffs on a hickman line?

Answer 30

inhibit microbial growth

Question 31

What is a triple lumen colored red white and blue called?

Answer 31

VasCath

Question 32

What influences the selection of CVCs?

Answer 32

Patient characteristics and preferences, patient history and co-morbidities, infusion needs, CVC options (tunneled vs non-tunneled, implanted port)

Question 33

What can daily site care of a tunneled line increase the chance of?

Answer 33

infection

Question 34

What should be assessed on a tunneled line daily?

Answer 34

patency, cleanliness, blood return, pain, swelling, integrity of the line

Question 35

What is included in a CVC assessment?

Answer 35

insertion site, exit site (redness, swelling), patency of each line, integrity of each line, clamps and caps, creates on chest, and pain in arm, shoulder, or neck

Question 36

What is the common policy for CVC line maintenance if there is no running IV?

Answer 36

SASH (Saline, Administer, Saline, Heparin)

Question 37

Why is a 10mL syringe always used for CVCs?

Answer 37

it decreases pressure in the catheter

Question 38

How should IV fluids be administered using a central line?

Answer 38

on a pump

Question 39

What are the potential complications of CVC insertion?

Answer 39

Pneumothorax, hematoma, infection, air embolism, wrong vein

Question 40

What is the average cost for each CVC infection?

Answer 40

$46000

Question 41

What kind of event is a vascular catheter-associated infection?

Answer 41

"never event"

Question 42

Best practices for preventing CVC infections? (the central line bundle)

Answer 42

Hand hygiene, maximum barrier precautions upon insertion, chlorhexadine, optimal catheter site selection (avoid femoral), daily review of need for a central line

Question 43

When should a CVC dressing be changed?

Answer 43

when damp, loosened, or soiled

Question 44

How often should a transparent CVC dressing be changed?

Answer 44

every 7 days

Question 45

How often should gauze be changed for CVCs?

Answer 45

every 24 hours

Question 46

What kind of technique is important to use to prevent catheter-related blood stream infections?

Answer 46

sterile technique

Question 47

What should be used at the exit site?

Answer 47

Biopatch

Question 48

What should be used for prep for a CVC dressing?

Answer 48

clorhexidine/alcohol prep with friction

Question 49

How long should the hubs be scrubbed for?

Answer 49

15-30 seconds

Question 50

4 complications of CVCs

Answer 50

intraluminal occlusion, fibrin formation, venous thrombosis, drug precipitation