PICC's Port's CVC's and other access devices

Question 1

What is the indication for a peripheral catheter?

Answer 1

– IV administration
– administration of antibiotics
– administration of certain cytotoxic drugs

Question 2

What are the contraindications of a peripheral catheter?

Answer 2

– long-term treatment
– certain cytotoxic drugs
– total parenteral nutrition (TPN)
– medications with a PH of less than 5 or greater than 9

Question 3

what are the complications of a peripheral catheter?

Answer 3

– Disconnection
– Dislodgement
– Infiltration
– phlebitis

Question 4

What is a PICC?

Answer 4

Peripherally Inserted Central Catheter

Question 5

What is a PICC used for?

Answer 5

– antibiotic therapy
– IV fluids
– TPN
– Blood sampling

Question 6

What are the advantages of a PICC?

Answer 6

• preserves venous access
• one cannula only
• easy to insert
• fewer complications on insertion

Question 7

Who can insert a PICC, and how is it done?

Answer 7

inserted by registered nurses who are trained in the procedure

sterile aseptic technique

Question 8

How is a PICC removed?

Answer 8

• Remove dressing from bottom upward
• Don sterile gloves
• Clean site
• Place swab at exit site
• Gently withdraw catheter
• Apply pressure to exit site for 5 minutes
• Tip may be sent for sensitivity and culture if infection is suspected
• Apply dressing

Question 9

What is a CVAD?

Answer 9

Central Venous Access Device

Question 10

What are the advantages of a CVAD?

Answer 10

• Inserted easily and quickly
• Can be used for several therapies
• Can be used for blood sampling

Question 11

What are the disadvantages of a CVAD?

Answer 11

• Complications associated with insertion

* Used as a temporary measure

Question 12

How is a CVAD inserted, anchored and what do you need to do before use?

Answer 12

• By Medical practitioners
• Anchored using a skin suture
• Check chest x-ray prior to use

Question 13

How do you care for a CVAD?

Answer 13

• Strict aseptic technique
• Lumens should be flushed before and after
• To prevent infection dressings should also be changed a minimum every seven days or sooner if no longer intact or soiled
• A transparent dressing should be used to allow visual inspection of insertion site

Question 14

How should a CVAD be removed?

Answer 14

• Similar to PICC removal
• Suture or securement device must be
removed first
• Head down tilt to prevent complications

Question 15

What are the 5 complications of a CVAD? explain each

Answer 15

CATHETER OCCLUSION
• Clamped or kinked catheter 
• Tip against wall of vessel
• Thrombosis
• Precipitate buildup in lumen
EMBOLISM
• Catheter breaking
• Dislodgement of thrombus 
• Entry of air into circulation

Long term 
INFECTION
• Contamination during insertion or use
• Migration of organisms along catheter • Immunosuppressed patient
PNEUMOTHORAX
• Perforation of visceral pleura
CATHETER MIGRATION
• Improper suturing
• Trauma, forceful flushing

Question 16

What are portacath?

Answer 16

• Treatment is administered through the skin overlying the reservoir. The reservoir is punctured with a needle and treatment is given
• Ports and access needles are available in many different types and sizes, allowing device choice to be tailored to each individual’s

Question 17

What are portacaths?

Answer 17

Implantable ports that are used for the same reasons as any other central venous access device but are viewed as a long-term device for use in hospital and the community as they are easy to maintain and have few associated complications

Question 18

What are the advantages of portacaths?

Answer 18

• Good for long-term therapy
• Low risk of infection
• Cosmetic discretion

Question 19

What are the disadvantages of a portacath

Answer 19

• catheter/port malfunction
• catheter rupture and embolisation
• venous thrombosis
• Infection

Question 20

How is a portacath inserted?

Answer 20

• Insertion and removal of implantable ports is very similar to insertion and removal of tunnelled central venous catheters
• Insertion and removal should only be carried out by experienced and competent professionals
• Implantable port insertion is a surgical technique which must be carried out within strict aseptic guidelines

Question 21

How do you care for a portacath?

Answer 21

• Accessing implantable ports should also always be carried out using strict aseptic techniques
• Needles, once in situ, should be secured to prevent trauma and dislodgement with the use of a transparent dressing
• No needle insitu require no dressing