Module 1: CVADs. Part 2: NT-CVADs

Question 1

How often should the needle free connector be chanfged

Answer 1

every 7 days
if removed for any reason
When there is blood visible that cannot be flushed clear

Question 2

how long NT-CVADs used for?

Answer 2

10-14 days

Question 3

Common complications for NT-CVADs

Answer 3

Occlusion: mechanical, thrombotic, chemical
Infxn: intraluminal or extraluminal
Venous Thrombosis: External to catheter attached to vein wall

Question 4

What are the 3 different types of catheter occlusions:

Answer 4

Partial Occlusion: Dec. Ability to infuse; resistance with flushing and aspiration, sluggish flow and blood return

Withdrawal Occlusion: Inability to aspirate blood but abililty to infuse w/o resistance. Lack or free-floweing blood return

Complete Occlusion: Inability to infuse fluids or aspirate blood

Question 5

What is biofilm

Answer 5

• A coating on all int. and ext. catheters that provides a matrix for bacteria to grow and persist
• CVADs can also become infected if the pt has a baterial or systemic infxn

Question 6

what is phlebtis and what are the 3 different kinds?

Answer 6

Inflmn in one all layers of the vein

3 types: mechanical chemical, bacterial

Question 7

What is a catheter-related venous thrombosis?

Answer 7

Catheter-related venous thrombosis occurs when the thrombus extends
outside of the CVAD, compressing the adjacent vein and restricting blood flow.

Question 8

What is Virchow’s triad of factors of thrombus development?

Answer 8

o Vessel wall damage/injury
o Alteration in blood flow
o Hypercoagulability.

Question 9

what are signs and symptms of venous thrombosis?

Answer 9

• edema
• distended jugular veins
• pain
• difficulty breathing
• Discoloration
• SVC syndrome

Question 10

What is SVC syndrome

Answer 10

• total occlusion of vein in sup. vena cava
• medical emergency
• facial flushing and swelling, beck pain or swlling, headache or sensation of fullness or head rush

Question 11

Managemnet of thrombosis

Answer 11

Notify MRN and physcian

Venogram or US

Anticoag therapy

Removal of line as per order

Question 12

Catheter Fracture?

Answer 12

A break or tear in the catheter. Can cause forceful flushing, pinch-off syndrome or accidental cutting of catheter

Question 13

Management of catheter migration

Answer 13

• CX
• Inform physician
• Ensure catheter is secure

Question 14

Management of external catheter fracture?

Answer 14

clamp line STAT. Use tooth clamp or flood catheter over and secure with dressing to prevent an air emobus, infxn or blood loss

Question 15

Management of internal catheter fracture?

Answer 15

SS of infiltration, leakage at site, no blood return. Notify physician. Keep clamped until it can be removed

Question 16

Air embolus?

Answer 16

Air entry into vascular system that prevents blood ejection from r. side of heart

Question 17

Causes of an embolus?

Answer 17

Line fracture

Not applying clamps when necessary

Deep inspiration when catheter removed

Not using appropriate dressing

Question 18

signs and symptoms of an embolus?

Answer 18

Hypoxia, rapid onset of SOB, coughing, anxiety

Hypotension

Cyanosis

Palpitations or arrhythmias, weak rapid pulse

Chest and should pain

Palpitations, arrhythmias, hypotension

Loss of consciousness

Question 19

Prevention of an embolus?

Answer 19

Close clamps when neccessary

Question 20

What is themost common complication of CVADs?

Answer 20

Infxn

Question 21

What is the most life threatening complication of NT-CVC’s?

Answer 21

An AIR EMBOLISM is potentially the most deadly complication associated with
CVC’s. It can occur as the catheter is inserted and removed, but the risk of air
embolism is present as long as the catheter is in situ.

Question 22

List 3 possible causes of an air embolism in a NT-CVC:

Answer 22

Line fracture
 Not applying clamps when removing needle free connectors
 Deep inspiration during removal
 Persistence of a catheter track once removed and not covered with an
appropriate occlusive dressing

Question 23

List four things a nurse can routinely do to minimize the chance of air entering the system
when working with a NT-CVC

Answer 23

Ensure the lumen is clamped prior to opening the system
 Keep a blue clamp or padded forcep with patient in case of catheter breakage
 Use Luer lock connections
 Having patient perform Valsalva maneuver (forcible exhalation against a closed
glottis) when removing because risk of air embolism is high

Question 24

Nursing interventions for air embolus

Answer 24

Clamp IV
 Call for help (may need to call a Code Blue) as you Place client in left
Trendelenburg position – (pt. is put on LEFT side with head down)-
 Administer O2
 Assess vital signs, breath sounds
 Notify the physician
 Document your assessment and your nursing interventions

Question 25

It is not necessary to have sutures in place to secure a CVAD . T/F?

Answer 25

True

Question 26

Based on the definition of catheter patency, a catheter is deemed “patent” when there is ability to easily aspirate blood from the catheter lumen in addition to...

Answer 26

The ability to easily infuse or flush fluid through the catheter lumen

Question 27

One specific sign for withdrawal occlusion is...

Answer 27

Lack of free-flowing blood return

Question 28

One strategy to prevent CVAD occlusions includes flushing the CVAD lumen(s) routinely with an appropriate amount of flush solution (such as N/S) especially at which time?

Answer 28

In-between the administration of incompatible medications or solutions

Question 29

How long should the infusion be stopped for prior to blood draw?

Answer 29

5 min

Question 30

How much NS to flush post blood draw?

Answer 30

20mL