Module 1: Part 1 - PICC Flashcards
Who is legally allowed to place a VAD?
Physicians or specially trained nurses.
How does a CVAD differ from a short-peripheral or midline catheter?
The furthest tip of the catheter in a CVAD ends in a larger BV.
Where should the tip of a CVAD placed in the upper body end?
In the lower segment of the inferior or superior vena cava at, or near, the cavoatrial junction.
Where should the tip of a CVAD placed in the lower body end?
In the inferior vena cava above the level of the diaphragm.
In adults, where should the tip of a CVAD placed in the femoral region end?
Nowhere, this is not recommended for adults.
What factors should be considered when determining placement of a CVAD?
(7, know at least 4)
- 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
What material is a CVAD composed of?
Silicone or polyurethane.
CVADs may be coated in what kinds of solutions? (4)
- Silver
- Antibiotics
- Minocycline/rifampin
- Chlorhexidine
(Fuck those last 2…they’ll be wayyy too hard to remember…)
What are 2 possible catheter tip configurations?
- Open-ended
2. Valve ended
How would you describe and open-ended catheter tip?
Similar to the tip of a straw.
How would you explain a valve ended catheter tip?
A rounded tip with a 3-way-pressure-activated valve.
What are some benefits of a valve ended catheter?
Prevents reflux of blood into the catheter to reduce the risk of hemorrhage, air embolism, and occlusion.
Is heparin needed to maintain patency in a CVAD?
No, but it still needs to be flushed with NS.
Do CVADs have single or multiple lumens?
Either!
Why might pt have a device with multiple lumens?
If they require numerous infusions and blood samplings, or if their medications are incompatible, but still need to be administered simultaneously.
Explain what an implanted venous port is.
A CVAD that has a reservoir placed in a “pocket” under the skin with the catheter inserted into a major vessel.
Where is the hub for an implanted port?
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.
How often does an implanted port need to be flushed?
Monthly with a heparin solution or NS.
Key components of the IHI Central Line Bundle: (5)
- 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
What sterile barrier supplies should the physician or nurse inserting the catheter be wearing?
- Head covering
- Gown
- Mask
- Sterile gloves (powder free)
Prior to insertion, assess the pt’s _______ status and what does this include?
Hydration status, this includes assessing the skin turgor, dryness of the mouth, skin texture, and fluid intake/output.
Before drawing blood, how long should all infusion be stopped (unless unable to stop)?
1-5 minutes.
If you are unable to stop infusions before drawing blood, what should you do instead?
Draw the sample from a peripheral vein.
When drawing up a sample from a multilumen catheter, does it matter which lumen you draw from?
Yes, you should draw it from the distal lumen (unless specified otherwise by the manufacturer).
How many mLs of blood should you draw up for the discard sample in a pediatric pt? How many for an adult pt?
Peds: 3 mLs
Adult: 6 mLs
When changing the injection cap, if the pt’s catheter is not clamped, what should you instruct the pt to do?
Ask the pt to perform the Valsalva maneuver as the new cap is applied.
What should you evaluate post-insertion?
- 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
When drawing up blood for a blood culture (not sample) should the site be flushed prior?
Nope.
When drawing up blood for a blood culture, how many mLs should be discarded in a pediatric pt? How many for an adult pt?
None for either.
How is the blood for a culture drawn up?
It is not drawn up from the needle-free connector, this is actually removed and the blood is drawn directly from the hub.
After removing the old needle-free connector for you blood culture, what should you do next?
Replace a new needle-free connector and flush with 10-20 mLs sterile NS, or until needle-free connector and extension set are clear.
Why are irritant drugs, fluids, and vesicants safer to be given via CVAD vs PIV?
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.
Why is right sided insertion is preferred over left for PICCs?
Due to the shorter straighter vein pathway
Why is the basillic vein usually chosen if possible?
due to its size and typically less tortuous pathway
How long can a PICC stay in place?
As long as no complications of occlusion or infection are present
How often should the external segment of a PICC be measured and recorded?
Every shift
How often should the dressing of a PICC be changed?
Every 7 days, unless its a gauze dressing, then its every 2 days
How many mLs are used to flush a PICC?
10-20mLs
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.
F, you must flush all of them
