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N243 > Module 1: Part 1 - PICC > Flashcards

Module 1: Part 1 - PICC Flashcards

1
Q

Who is legally allowed to place a VAD?

A

Physicians or specially trained nurses.

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2
Q

How does a CVAD differ from a short-peripheral or midline catheter?

A

The furthest tip of the catheter in a CVAD ends in a larger BV.

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3
Q

Where should the tip of a CVAD placed in the upper body end?

A

In the lower segment of the inferior or superior vena cava at, or near, the cavoatrial junction.

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4
Q

Where should the tip of a CVAD placed in the lower body end?

A

In the inferior vena cava above the level of the diaphragm.

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5
Q

In adults, where should the tip of a CVAD placed in the femoral region end?

A

Nowhere, this is not recommended for adults.

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6
Q

What factors should be considered when determining placement of a CVAD?
(7, know at least 4)

A
  • Type and duration of infusion therapy
  • Vascular characteristics
  • Age
  • Co-morbidities
  • Hx of infusion therapy
  • Preference for location
  • Osmolarity and pH of the solution to be administered
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7
Q

What material is a CVAD composed of?

A

Silicone or polyurethane.

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8
Q

CVADs may be coated in what kinds of solutions? (4)

A
  • Silver
  • Antibiotics
  • Minocycline/rifampin
  • Chlorhexidine
    (Fuck those last 2…they’ll be wayyy too hard to remember…)
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9
Q

What are 2 possible catheter tip configurations?

A
  1. Open-ended

2. Valve ended

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10
Q

How would you describe and open-ended catheter tip?

A

Similar to the tip of a straw.

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11
Q

How would you explain a valve ended catheter tip?

A

A rounded tip with a 3-way-pressure-activated valve.

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12
Q

What are some benefits of a valve ended catheter?

A

Prevents reflux of blood into the catheter to reduce the risk of hemorrhage, air embolism, and occlusion.

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13
Q

Is heparin needed to maintain patency in a CVAD?

A

No, but it still needs to be flushed with NS.

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14
Q

Do CVADs have single or multiple lumens?

A

Either!

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15
Q

Why might pt have a device with multiple lumens?

A

If they require numerous infusions and blood samplings, or if their medications are incompatible, but still need to be administered simultaneously.

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16
Q

Explain what an implanted venous port is.

A

A CVAD that has a reservoir placed in a “pocket” under the skin with the catheter inserted into a major vessel.

17
Q

Where is the hub for an implanted port?

A

There is no hub, access to an implanted port is gained only by inserting a special 90 degree angle, noncoring needle through the skin and into the self-sealing injection port in the septum of the reservoir.

18
Q

How often does an implanted port need to be flushed?

A

Monthly with a heparin solution or NS.

19
Q

Key components of the IHI Central Line Bundle: (5)

A
  • HH before and after catheter insertion
  • Maximal sterile barrier precautions with insertion
  • Chlorhexidine gluconate (CHG) skin antisepsis
  • Optimal catheter site selection
  • Necessity of daily review of the condition of the line
20
Q

What sterile barrier supplies should the physician or nurse inserting the catheter be wearing?

A
  • Head covering
  • Gown
  • Mask
  • Sterile gloves (powder free)
21
Q

Prior to insertion, assess the pt’s _______ status and what does this include?

A

Hydration status, this includes assessing the skin turgor, dryness of the mouth, skin texture, and fluid intake/output.

22
Q

Before drawing blood, how long should all infusion be stopped (unless unable to stop)?

A

1-5 minutes.

23
Q

If you are unable to stop infusions before drawing blood, what should you do instead?

A

Draw the sample from a peripheral vein.

24
Q

When drawing up a sample from a multilumen catheter, does it matter which lumen you draw from?

A

Yes, you should draw it from the distal lumen (unless specified otherwise by the manufacturer).

25
Q

How many mLs of blood should you draw up for the discard sample in a pediatric pt? How many for an adult pt?

A

Peds: 3 mLs
Adult: 6 mLs

26
Q

When changing the injection cap, if the pt’s catheter is not clamped, what should you instruct the pt to do?

A

Ask the pt to perform the Valsalva maneuver as the new cap is applied.

27
Q

What should you evaluate post-insertion?

A
  • Auscultate breath sounds and evaluate for SOB, chest
    pain, and/or absent breath sounds
  • Monitor vital signs, including HR and rhythm
  • Monitor pt complaints of pain, numbness, tingling, or
    weakness
28
Q

When drawing up blood for a blood culture (not sample) should the site be flushed prior?

A

Nope.

29
Q

When drawing up blood for a blood culture, how many mLs should be discarded in a pediatric pt? How many for an adult pt?

A

None for either.

30
Q

How is the blood for a culture drawn up?

A

It is not drawn up from the needle-free connector, this is actually removed and the blood is drawn directly from the hub.

31
Q

After removing the old needle-free connector for you blood culture, what should you do next?

A

Replace a new needle-free connector and flush with 10-20 mLs sterile NS, or until needle-free connector and extension set are clear.

32
Q

Why are irritant drugs, fluids, and vesicants safer to be given via CVAD vs PIV?

A

Because the tip of the catheter ends in the vena cava, which has a much blood flow than peripherally and therefore is able to tolerate a pH of less than 5 or greater than 9, or osmolality greater than 900 with less risk of vein irritation due to increased hemodilution and vessel size.

33
Q

Why is right sided insertion is preferred over left for PICCs?

A

Due to the shorter straighter vein pathway

34
Q

Why is the basillic vein usually chosen if possible?

A

due to its size and typically less tortuous pathway

35
Q

How long can a PICC stay in place?

A

As long as no complications of occlusion or infection are present

36
Q

How often should the external segment of a PICC be measured and recorded?

A

Every shift

37
Q

How often should the dressing of a PICC be changed?

A

Every 7 days, unless its a gauze dressing, then its every 2 days

38
Q

How many mLs are used to flush a PICC?

A

10-20mLs

39
Q

T or F:

After using one lumen of a multi-lumen PICC, you must flush the one you used and swab the ones you didn’t.

A

F, you must flush all of them

N243 (6 decks)

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