CVC

Question 1

Uses of CVCs

Answer 1

TPN (peripheral veins can’t handle high dextrose and glucose levels), chemo, long-term abx, loss of peripheral access

Question 2

“Deep line”

Answer 2

Non-tunneled CVC

Question 3

Non-tunneled CVCs

Answer 3

• tip lies in the superior VC
• inserted by the HCP or specialized RN
• short-term—not for home

Question 4

Where does a deep line enter?

Answer 4

Subclavian or internal jugular

Question 5

Risks of nontunneled CVCs

Answer 5

Nicking the pleura (pneumothorax), bleeding, air embolism

Question 6

What kind of non-tunneled CVC is best for noncompatible drugs

Answer 6

3 lumen

Question 7

Type of tunneled CVCs

Answer 7

Hickman, Groshong, Broviac

Question 8

Why do most patients have tunneled CVCs?

Answer 8

For chemo

Question 9

Implanted ports

Answer 9

• aka portacath or PowerPorts
• implantable venous access
• no external tubing

Question 10

Peripherally inserted central catheter (PICC)

Answer 10

Tip lies in superior vena cava, end comes out on arm

Question 11

CLABSI

Answer 11

Central line associated bloodstream infection
- bacteria in the line

Question 12

Non-tunneled CVC removal

Answer 12

• check INR if on anticoagulant
• need sterile suture removal kit, sterile and clean gloves, occlusive dressing, measuring tape
• explain procedure
• lay supine or trendelenburg
• Valsalva maneuver—ask pt to hum
• pressure for 3-5 minutes, occlusive dressing

Question 13

IV Cath dressing

Answer 13

Statlock—stabilization device—Dec wiggling, hole size, infection

Question 14

Tunneled CVC

Answer 14

• does not go thru the vein from skin—tunnels thru tissue to get to skin internally
• placed in OR
• used when infusion therapy is frequent and prolonged (even years)
• irrigation protocol varies—may need heparin
• site dressing per policy
• removed by HCP

Question 15

Advantages and disadvantages of tunneled CVC

Answer 15

Adv—no needle sticks
Disadv—break in skin integrity

Question 16

Complications of tunneled CVCs

Answer 16

Catheter damage, occlusion, thrombosis, sepsis

Question 17

Implanted port

Answer 17

• under SQ tissue
• for pt who need semi-permanent IV access up to 1 year
• placed in OR, Cath attached to port, placed in pocket of SQ tissue on chest wall
• irrigation protocol varies
• no site care
• HCP removes
• complication—occlusion

Question 18

What type of needle is used for implanted port and how long can it be used?

Answer 18

Huber needle
- can get up to 2000 punctures with Huber in chest
- can get 750 punctures in upper arm
- change needle weakly

Question 19

Complication of implanted port

Answer 19

Occlusion

Question 20

Advantage of implanted ports

Answer 20

Least impact on body image

Question 21

PICC line

Answer 21

• nontunneled
• tip lies in superior vena cava
• peripherally inserted
• inserted at bedside in bend of elbow (antecubital fossa or cephalic vein)
• no BP/sticks in arm
• lasts 3-12M

Question 22

post-procedure for deep tunnel

Answer 22

Chest X-ray

Question 23

Complications of PICC line

Answer 23

Phlebitis, catheter occlusion

Question 24

Benefit of PICC line

Answer 24

Fewer complications that CVC—fewer microorganisms on arm and easier to insert

Question 25

PICC line removal procedure

Answer 25

RN removes
- bear down, hold arm below heart, w/d inch by inch and pause to avoid vasospasm; don’t pull if vein spasms
- measure length at the end

Question 26

Only thing UK students can do with a CVC

Answer 26

Hang secondary is a primary is already running