Module 5: Vascular Access Devices and Sites

Question 1

What is an Arterial Line (a-line, art line)

Answer 1

Catheter placed on artery. Commonly in the radial artery.

Question 2

Purpose of A-line

Answer 2

collect blood gas and other blood specimen, and administer drugs such as dopamine

Question 3

Reminders for A line

Answer 3

Only specialized personnel can access.
Never place tourniquet

Question 4

What is an Arteriovenous Shunt, Fistula, or Graft?

Answer 4

permanent surgical connection of an artery and vein by direct fusion (fistula)— results in bulging vein. Or with piece of vein or tubing (graft) that created loop under skin.

Question 5

Purpose of AV fistula, shunt, graft

Answer 5

For dialysis— joins radial artery and cephalic vein above wrist on underside of the arm.

Question 6

Buzzing sensation in AV fistula, shunt, graft

Answer 6

Thrill

Question 7

What i a blood sampling device?

Answer 7

Needless closed blood sampling device. Connected to arterial or central venous catheter for blood collection.

Question 8

Advantages of Blood Sampling Device

Answer 8

1. less risk of infection
2. no neddlestick injury
3. less waste

Question 9

Example of blood sampling device

Answer 9

VAMP (venous arterial blood management protection system)

Question 10

What is a heparin or saline lock?

Answer 10

catheter or cannula connected to a stopcock or cap with diaphragm used for administering medication or blood collection. Placed on a vein in the lower wrist and can be left up to 48 hours. Often flushed with heparin or saline to prevent clotting of blood.

Question 11

How many ml should be removed in heparin or saline locks before collecting for tests?

Answer 11

5ml in discard tube

Question 12

What test is not recommended for blood collected from heparin or saline locks?

Answer 12

Coagulation tests

Question 13

What does intravenous mean and what is it?

Answer 13

“of, pertaining to, or within a vein”. Catheter inserted in a vein to administer fluids (also known as IV).

Question 14

Can blood specimens be drawn from IV sites?

Answer 14

No. they can be contaminated with fluids or diluted with IV fluids.

Question 15

Alternative choice if both arms have IV line?

Answer 15

1. capillary puncture
2. If large amounts are needed, find other sites such as foot or ankle
3. below IV line

Question 16

Steps to follow when collecting blood from IV line

Answer 16

1. ask nurse to turn off IV for at least 2 minutes prior collection
2. Apply tourniquet distal to line
3. select site distal to IV
4. Perform venipuncture in dif. vein than the one with IV
5. Ask nurse to restart
6. Document that specimen was collected under IV

Question 17

How many hours should pass before collecting specimens from previous IV sites?

Answer 17

24-48 hours (1-2 days)

Question 18

What are Central Vascular Access Devices?

Answer 18

Also known as INDWELLING LINE. These are tubings inserted on main vein or artery. Used for administering medication, monitoring pressure, drawing blood.

Question 19

Benefits of CVADs?

Answer 19

1. practical for patients who need extended time for IV line
2. beneficial for patients who do nor have easily accessible veins.

Question 20

Only specially trained personnel can have access to CVADs to draw blood, but phlebotomist can assist in placing specimen in proper tubes.

True or False?

Answer 20

TRUE

Question 21

Use of saline or heparin in CVADs?

Answer 21

Flush solutions to avoid thrombosis

Question 22

How much blood should be discarded to avoid contamination of flush solution?

Answer 22

Non-coagulation: 2x dead space
Coagulation: 6x dead space (about 5mL)——- typically not recommended

Question 23

Three types of CVADs?

Answer 23

1. CVC- central venous catheter or central venous line
2. Implanted port
3. PICC- Peripherally Inserted central catheter

Question 24

Describe CVC?

Answer 24

Line inserted in large vein such as subclavian ad into the superior vena cava, proximal to right atrium.
Exit is surgically tunneled under skin to site several inches away the chest.
Has one or more short tubings that protrude from exit site, covered with transparent dressing.

Question 25

Describe Implanted port

Answer 25

Small chamber attached to an indwelling line that is surgically implanted under skin and most commonly located in upper chest or arm. Can be located by palpating skin and accessed by inserting special needle through skin into self-sealing septum of chamber. Not covered with bandage.

Question 26

Describe PICC or Peripherally inserted central catheter

Answer 26

line inserted in peripheral venous system (veins of the extremities) and threaded into central venous system (main veins). No need for surgery. Placed in an antecubital vein, below or above antecbital fossa.