Chapter 16: Parenteral Access Devices

Question 1

Define diameter.

Answer 1

Can refer to the internal or external diameter and is measured in millimeters

Question 2

Define french size.

Answer 2

A measure of the outer diameter (1 mm = 3 Fr)

Question 3

Define gauge.

Answer 3

A unit of measure that is inversely proportional to the catheter’s outer diameter

Question 4

What are the CDC guidelines for peripheral access?

Answer 4

Recommend close monitoring; with the peripheral IV line removed no more frequently than every 72 to 96 hours, unless clinically indicated.

Question 5

What is purpose of cuffs?

Answer 5

Cuffs attached to CVCs are designed to serve as subcutaneous anchors and mechanical barriers.

Question 6

What is the most commonly used line for the acute care setting, for short duration?

Answer 6

Nontunneled, noncuffed CVADs; they have a dwell time of 5 to 7 days.

Question 7

Define CVAD

Answer 7

Central Venous Access Devices

Question 8

Define PICC.

Answer 8

Peripherally Inserted Central Catheter A catheter inserted via a peripheral vein with the tip in the SVC (superior vena cava); classified as nontunneled

Question 9

What are the 3 categories of CVADs?

Answer 9

1. Nontunneled
2. Tunneled
3. Implanted

Question 10

(TRUE/FALSE)

Stabilization devices are necessary to maintain PICC placement and avoid malposition.

Answer 10

TRUE

Question 11

Describe tunneled central venous catheters, including their advantages.

Answer 11

Silicone elastomer catheter was inserted by subclavian venipuncture, with the distal tip placed in the midatrium; last for months to years

Advantages:

• Ease of self-care by the patient
• Placement on the chest wall so they are covered by clothing
• Decreased risk of dislodgement
• Ability to reapir the external lumen in the event of catheter breakage

Question 12

Describe TIVADs

Answer 12

Totally Implanted Venous Access Devices (TIVADs)

Consist of silicone or polyurethane catheter attached to a portal reservoir made of stainless steel, polysufone or titanium with a self-sealing silicon elastomer septum

Can be implanted into the subcutaneous pocket in the upper chest, upper arm, or forearm.

Question 13

What are the patient factors to consider when choosing an appropriate catheter?

Answer 13

• Safe
• Meets the patient’s needs
• Cost-effective
• Type of medication/solution to be delivered
• Overall therapeutic regimen
• Anticipated duration of therapy
• Patient’s lifestyle
• Potential impact of the device on the patient’s body image
• Their activity level

Question 14

How often should CVADs and mid-line catheters be assessed? For peripheral catheters?

Answer 14

Daily

At least Q 4 hours

Question 15

What are the appropriate antiseptic agents for cleaning a catheter exit site?

Answer 15

• CHG (chlorheidine gluconate)
• 70% alcohol
• 10% povidone-iodine

Question 16

What are the appropriate drying times for catheter sites?

Answer 16

• Alcohol/CHG: must dry at least 30 seconds
• Iopophors: at least 1.5 to 2 minutes

Agents must be fully dried before dressing is applied.

Question 17

(TRUE/FALSE)

Routine use of antibiotic ointments at the catheter insertion site is recommended.

Answer 17

FALSE

Not recommended because they may change the bacterial flora and contribute to the emergence of resistant bacteria or fungi

Question 18

Define hub.

Answer 18

The end of the VAD that connects to the medication tubing or caps.

Question 19

Define CRBSIs.

Answer 19

Catheter-related Bloodstream Infection

Includes: Elevated WBC (greater than 10,500/mcL), fever, chills, N/V, hypotension, tachycardia

Question 20

(TRUE/FALSE)

VADs should be assessed for blood return prior to each infusion and flushed with NS after each infusion to clear all infused medications or solutions.

Answer 20

TRUE

These steps help ensure catheter patency by reducing the risk of incompatible medications causing preciptations, and decreasing the risk of intraluminal occlusion by the reflux of blood into or remaining in the catheter.

Question 21

Define a locking VAD.

Answer 21

The instillation of a limited amount of antimicrobial or antiseptic solution with sufficient volume to fill the internal priming volume of the catheter, following routine catheter flush.

Solutions include:

• Ethanol
• Taurolidine
• Citrate
• 26% sodium chloride
• EDTA

Question 22

(TRUE/FALSE)

CDC guidelines recommend that the practice should be limited to patients with long-term catheters who have a history of multiple CRBSIs, and a systematic review of the clinical trials supported by this recommendation.

Answer 22

TRUE

Question 23

Define CLABSI.

Answer 23

Central Line-Associated Bloodstream Infection; Clinical term used for diagnosis and tx of BSI

A labatory-confirmed BSI in which the central line or umbilical catheter was in place for more than 2 calendar days on the date of the event, with day of device placement being Day 1, AND the line was also in place on the date of event or the day before.

Question 24

Describe the “Central Line Bundle.”

Answer 24

Proposed set of evidence-based practices,, which has been designed to reduce the incidence of infections associated with central lines.

1. Hand Hygiene
2. Maximal barrier precautions
3. CHG skin antisepsis
4. Optimal catheter site selection
5. Daily review of line necessity, with the prompt removal of unnecessary lines

Question 25

(TRUE/FALSE)

In reference to the “Central Line Bundle,” failure to complete any aspect of the bundle is regarded as noncompliance with the entire protocol.

Answer 25

TRUE

Question 26

How is catheter patency defined?

Answer 26

With 2 criteria: the ability to infuse without resistance and the ability to aspirate blood without resistance. When either of these criteria is not met, the catheter is occluded.

Question 27

Define venous thrombosis.

Answer 27

Refers to a thrombus in the vessel that may partially or totally occlude the vessel.

Question 28

What is Alteplase?

Answer 28

A tissue plasminogen activator, approved thrombolytic agent for CVAD occlusions.

2 mg in a 2-mL volume is injected into the catheter and allowed to dwell for 30 minutes to 4 hours, then aspiration of the solution is attempted. Repeat if necessary.

Question 29

(TRUE/FALSE)

In patients with catheter-associated mural or venous thrombosis, catheter removal is recommended as the first treatment.

Answer 29

FALSE, it is NOT recommended.

Question 30

What are the leading causes of intraluminal occlusions?

Answer 30

1. Drug-heparin interactions
2. PN formulations
3. Lipid residue

Question 31

(TRUE/FALSE)

The use of a 0.9% NS flush between all IV medications, infusions, and heparin is the key to prevention.

Answer 31

TRUE