Ch 16: Parenteral Access Devices Flashcards
What are CVC most commonly made of?
polyurethane or silicone
If duration of therapy is considered to be < 1 week of nonirritant, nonvesicant, and non-hyperosmolar infusion therapy, what type of line should be considered?
Peripheral line
How often should peripheral line be changed?
CDC recommends monitoring of peripheral access with IV line removed no more frequently than every 72-96 hours unless clinically indicated
Thrombotic occlusions are usually treatment with what?
Thrombolytics
In what situations should a PICC line be placed with caution?
In patient with CKD with need to preserve peripheral/central veins for possible AV graft creation
How are catheter sizes expressed?
as diameter, French size, and gauge. Diameter can refer to internal or external diameter and is measured in millimeters
What type of line is suited for peripheral compatible solutions where treatment is considered for 2-6 weeks
Midline catheters
Why would a port be placed?
Mediports are subcutaneous access ports implanted under the skin. They provide a way for long-term venous access without multiple needle pricks. They are used for treatments such as chemotherapy, intravenous medication and blood transfusions.
What is the measure of French size?
outer diameter (1 mm= 3 French)
What is a central line bundle?
5 components recommended to reduce risk of CRBSI
o Hand hygiene o Maximal barrier precautions o CHG skin antisepsis o Optimal catheter site selection o Daily review of line necessity with prompt removal of unnecessary lines
When would of use of percutaneous nontunneled catheter be appropriate?
In acute care settings for therapies of short duration; dwell time is limited to 5-7 days
What is a PICC line classified as?
Non tunneled CVAD
What are the advantages of a tunneled CVC?
decreases risk of catheter infection by separating the exit and venipuncture sites; in general, is correlated with lower rates of infection , save and effective in long term therapies ranging from months to years, ease of self-care by patient, placement on chest wall so covered by clothing, decreased risk of dislodgement, ability to repair the external lumen in even of catheter breakage
What is the preferred vessel for central access and infusion of PN?
The Superior Vena Cava (SVC) has estimated blood flow of 2000 mL/minute making in the preferred vessel
How long can a PICC line dwell?
Appropriate for infusion of irritants and vesicants (such as PN) and chemo, for any length of duration with PIC lines dwelling for months to years
What is a fibrin sheath?
A fibrin sheath, or fibrin sleeve, is a thrombotic catheter occlusion and develops when fibrin adheres to the external surfaces of the catheter.
True or false: Prophylactic use of antibiotic ointment at the catheter exit site should be used.
False; Prophylactic use of antibiotic ointment at the catheter exit site encourages the development of resistant flora and should be avoided
According to the Centers for Disease Control and Prevention, research supports which recommendations as primary interventions for reducing risks of central venous access device-related infection?
(1) using maximal barrier technique during catheter insertion, (2) cleansing insertion sites with 2% chlorhexidine preparation, and (3) education and training of health care personnel.
True or false: Catheter-related blood stream infections often present without redness or purulence at the catheter site.
True
Discontinuation of lipid injectable emulsion (ILE) is recommended treatment for catheter-related bloodstream infection due to which organism?
Malassezia furfur
This occurs most commonly in premature infants and patients receiving PN containing ILE. The ILE presumably provides growth factors required for replication of the organism. Appropriate treatment of patients requires administration of antifungal therapy, discontinuation of ILE, and removal of the intravascular catheter, especially with nontunneled catheter infections.
Excess carbohydrate administration in PN has been associated with
Hepatic steatosis
A home PN dependent patient with a peripherally inserted central catheter (PICC) presents with arm, shoulder and neck swelling. What is the most likely cause?
Catheter related central venous thrombosis
Which of the following is a disadvantage of a peripherally-inserted central catheter (PICC)?
Limited self care ability
True or false: Regular catheter replacement scheduled time intervals has shown a decrease in CRBSI.
False; Catheter replacement at scheduled time intervals has NOT shown a decrease in CRBSI. Do not remove CVCs or PICCs based on fever alone.
Increased concentration of what reduces the risk of calcium phosphate precipitation?
Increased concentration of amino acids reduce the risk of calcium phosphate precipitation by forming soluble complexes with calcium, thereby reducing the free calcium ions available to form insoluble dibasic calcium phosphate precipitates.
Additionally, higher concentrations of amino acids may lower the pH of the PN formulation, which also improves calcium phosphate solubility
