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CNSC Exam > PN Access Devices > Flashcards

PN Access Devices Flashcards

1
Q

Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention sets ____ that create specialized vascular access teams

A

guidelines

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2
Q

what is the goal of an effective infection control program

A

eliminate CRBSI from all patient care areas

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3
Q

The major blood vessel that receives blood from the external jugular veins

A

Superior Vena Cava

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4
Q

what blood flow can the SVC can handle up to ____mL per min

A

2000mL

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5
Q

the preferred vessel or central access and infusion of PN solutions

A

SVC

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6
Q

maximum osmolarity peripheral veins

A

900mOsm/L

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7
Q

diameter of a catheter is the ____ or ____ diameter measured in mm

A

internal or external diameter

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8
Q

French size measures the _____ diameter of a catheter

A

outer

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9
Q

the gauge is a unit of measure that is ______ proportional to catheters of the outer diameter

A

inversely

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10
Q

____ lumen catheters allow for simultaneous infusion of multiple solutions or incompatible drugs’

A

multi-lumen

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11
Q

____ are attached to central venous catheters that act as subcutaneous anchors or mechanical barriers

A

cuffs

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12
Q

a ____ venous access device is a pressure sensitive, 3-2ay slit valve that prevents retrograde blood flow and eliminates the need for daily heparinized flushes

A

Groshong

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13
Q

moth IV catheters are made of _____

A

polyurethane

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14
Q

silicone IV catheters have an increased of _____ ____ formation

A

fibrin sleeve

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15
Q

catheter access is defined by the position of the

A

distal catheter tip

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16
Q

peripheral vein preservation should be considered when placing IV access. make sure solutions are these 3 things

A

non-irrtiant
non-vesicant
non-hyperosmolar

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17
Q

if a patient is fluid restricted, this type of access should not be used as they won’t be able to meet their nutrient needs

A

PPN

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18
Q

the most commonly used VAD are ____lines

A

peripheral

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19
Q

sings of thrombophlebitis

A

pain, erythema, tenderness

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20
Q

how often should peripheral IVs be changed

A

when clinically indicated

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21
Q

CDC guidelines suggest that close monitoring of _______ access and remove the IV line no more frequently than every ____ to ____ hours unless clinically indicated

A

peripheral, 72-96 hours

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22
Q

Midline catheters are 8-10 cm long and lower the rates of

A

phlebitis, lower infection

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23
Q

midline catheters are indicated for ___ to ___ weeks

A

2-6 weeks

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24
Q

midline catheters don’t need to be

A

frequently changed

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25
Q

non tunneled catheters are most often used in this setting

A

acute health care

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26
Q

non tunneled catheters are only indicated for ______ ___ use

A

short term

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27
Q

this is the method of placing non tunneled catheters by accessing the vein with a small needle, placing a guidewire and removing the needle

A

Seldinger approach

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28
Q

what is the dwell time of a non tunneled catheter

A

5-7 days

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29
Q

tunneled catheters are a ____ term catheter proven to be safe of therapy up to months/years

A

long term

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30
Q

advantages of a tunneled catheter

A

ease of self care of the patient, placed on the chest wall so it is covered by clothing, decreased risk of dislodgment

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31
Q

Totally Implanted Venous Access Devices are also called

A

subcutaneous Ports

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32
Q

This type of catheter is made up of a silicone or polyurethane catheter attached to a portal reservoir made of stainless steel, polysuflane or titanium

A

port

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33
Q

a port catheter can be accessed up to _____ to ____ times

A

1,000-2,000 times

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34
Q

port catheter’s have the _____ infection rates

A

lowest

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35
Q

picking an access device for a patient should take into consideration

A

safety, meets the patient’s needs, depends on medication needed, duration of therapy, impact on body image, impact on patient’s lifestyle and activity level

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36
Q

the ideal goal of home PN therapy is

A

to restore the patient to their prior level of function

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37
Q

the ____ the number of lumens the _____the chance or infection

A

lower, lower

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38
Q

what are contraindications to placing central venous access devices (CVADs)

A

change in Tx plan with sudden clinical deterioration
new/unexplained fever
absolute neutropenia <1,000 WBC per mL
platelet counts <50,000 plates within 2 hrs of placing

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39
Q

what is the MOST important thing to prevent infection/complications with IV placement

A

use of maximal barrier protections

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40
Q

maximal barrier protections include

A

cap, mask, disposable gown, gloves, large drape

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41
Q

immediate complications of catheter placement include

A

pneumothorax, air embolism, arrhythmia bleeding, cardiac tamponade

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42
Q

signs of pneumothorax

A

dyspnea, cough, hypoxia, chest pain with tachycardia

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43
Q

onset of chest pain, dyspnea, tachycardia, nausea, hypotension or enlarged neck veins can indicate this IV insertion complication

A

arrhythmia

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44
Q

_____ should be the only ones to use ultrasound guidance when placing IV’s

A

well trained clinicians

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45
Q

what is mandatory to do before using a IV after insertion

A

confirm the tip placement BEFORE use

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46
Q

what is the desired tip placement in the SVC

A

the distal 1/3 of the SVC or cavoartiral junction

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47
Q

what is the gold standard way to check IV placement

A

Chest Xray

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48
Q

this type of method uses P waves to provide real time tip confirmation as the catheter approaches the right atrium

A

Electrocardiography Guided CVAD

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49
Q

CVAD’s should be monitored every ___ hours in acute care

A

4 hours

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50
Q

the goal of catheter care is

A

to maintain vascular access and reduce the risk of complication

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51
Q

what can be used to clean a CVAD

A

chlorhexidine, 70% alcohol, or iodine

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52
Q

what is the MOST effective CVAD cleaning agent

A

Chlorhexidine

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53
Q

is routine use of antibiotic ointment on catheter insertion site recommended

A

NOOOOOOO

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54
Q

this part of the catheter that is the end of the VAD that connects to the medication tubing or caps

A

hub

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55
Q

what ensures catheter patency

A

assess blood return

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56
Q

what is a chemical agent that is not readily available in the U.S. shown to help prevent CRBSI’s

A

Taurolidine

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57
Q

what is the most common non-infectious complication with VADs

A

catheter occlusion

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58
Q

elevated WBC count >10,500 mc/L, fever, chills, malaise, nausea, vomiting, hypotension, tachycardia, headache, erythema, purulent exudate at insertion site and fever may indicate a

A

Catheter Related Bloodstream Infection

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59
Q

CLABSI stands for

A

Central Line Associated Blood Stream Infection

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60
Q

erythema or induration within 2 cm of the catheter exit site in the absence of concomitant BSI without concomitant purulence is indicative of

A

exit site infection

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61
Q

tenderness, erythema or site induration > 2cm of catheter site along the subcutaneous tract of a tunneled catheter in the absence of concomitant BSI

A

tunnel infection

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62
Q

purulent fluid in the subcutaneous pocket of a totally implanted IV catheter that might or might not be associated with spontaneous rupture and drainage or necrosis of the overlaying skin in the absence of a BSI

A

pocket infection

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63
Q

bacteremia or fungemia in a patient with IV catheter with at least 1 positive blood culture obtained from a peripheral vein is called

A

a blood stream infection

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64
Q

fever, chills and hypotension could indcate

A

a BSI

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65
Q

contamination of the IV catheter can come from these places

A

endogenous skin flora at insertion site
contamination of the hub by hands/devices
hematogenous seeding form a distant infection
contamination of the infusate

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66
Q

the most common cause of intraluminal contamination of long term VAD’s come from

A

the hub of the IV catheter

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67
Q

when a biofilm develops on an IV what should be done

A

remove the CVAD and start systemic antibiotics

68
Q

what is used to prevent the development of biofilm

A

antimicrobial catheter locks

69
Q

what is the primary cause of contamination that causes blood stream infections

A

hand contamination

70
Q

this was designed to reduce the incidence of infections associated with central lines by the institute of healthcare improvement which consists of 5 components including proper hand hygiene, maximal barrier precautions, CHG skin antiseptics, daily review of line necessity, optimal cath site selection and prompt removal of unnecessary lines

A

Central Line Bundle

71
Q

when a CRBSI is suspected what should be provided and how long should it dwell

A

70% ethanol cath lock solution 2mL for 6 hours

72
Q

when is appropriate to remove a CVC in the setting of infection

A

if it is a fungal infection or staff aureus

73
Q

_____ is an antiseptic that provides bactericidal activity to a broad range of bacteria and is less likely to promote bacterial resistance

A

70% ethanol lock solution

74
Q

an air embolism is a ____ condition and often fatal

A

rare

75
Q

sudden chest pain, dyspnea, headache and confusion and sometimes death are symptoms of

A

air embolism

76
Q

if a patient is suspected to have an air embolism of the VAD what should be done

A

clamp the catheter and place the patient immediately in Trendelenburg with left lateral decubitus position

77
Q

occlu sion of catheter lumens should be maintained at all times when not in use to prevent

A

air embolism

78
Q

a blood clot that breaks off from another thrombus in the body that travels to the lungs occluding pulmonary blood vessels is called

A

pulmonary embolism

79
Q

if a patient is suspected to have a pulmonary embolism what should be done

A

diagnose with a CT scan or ventilation perfusion scan and then use anticoagulation therapy

80
Q

what is the most common non infectious catheter related complication

A

catheter occlusion

81
Q

the ability to infuse into an IV without resistance and ability to aspirate blood without resistance is called

A

catheter patency

82
Q

if an IV does NOT have the ability to infuse without resistance and blood cannot be aspirated without resistance this indicates

A

an occlusion

83
Q

when a vessel wall injury occurs with catheter it leads to this type of occlusion

A

thrombotic

84
Q

A bundle of platelets and blood cells composed of fibrin developed after a vessel wall injury is known as a

A

venous thrombi

85
Q

this coagulation factor becomes cross linked and interwoven with platelets/leukocytes is known as

A

fibrin

86
Q

what catheter to vein ratio prevents a DVT

A

1:3

87
Q

risk factors for developing a thrombosis

A

catheter tip position, catheter material, type of infusate, length of catheter duration, multiple insertion attempts, previous CVC insertion

88
Q

other signs of catheter occlusion

A

neck vein distention, edema, tingling or pain, tight feeling in the throat

89
Q

inadequate flushing or blood reflux in the IV resulting in sluggish catheter Fx/occlusion is caused by

A

intraluminal clotting

90
Q

if there is evidence of intraluminal clotting what is the treatmet

A

flush 2x the volume with 5-10mL of normal saline

91
Q

a covering formed over the distal tip of the catheter is known as the

A

fibrin sheath

92
Q

how can you tell if there is intraluminal clotting

A

when you flush the IV with saline following blood aspiration is inadequate

93
Q

a sheath formed over the distal tip of a catheter is called

A

a fibrin sheath

94
Q

when you are unable to aspirated blood from a catheter but it is still working there may be a

A

fibrin sheath

95
Q

what is the best way to treat a fibrin sheath

A

thombolytic agent (atepelase)

96
Q

a thrombus within the vessel that may partially or totally occlude a vessel if called a

A

venous thrombosis

97
Q

this type of thrombosis may initially present as a venous obstruction

A

mural thrombus

98
Q

Ateplase should dwell for

A

30 mins to 4 hours

99
Q

this is a tissue plasminogen activator/thrombolytic agent used to get rid of IV thrombi

A

Ateplase

100
Q

is catheter removal the first line of action

A

NOOOOO

101
Q

other non occlusive causes of poor IV blood flow

A

kinks, sutures, clamps

102
Q

an intermittent mechanical obstruction related to postural changes caused by catheter compression between the clavicle and 1st rib is called

A

catheter pinch off syndrome

103
Q

what is the first line of therapy when catheter pinchoff syndrome is detected

A

remove the IV line

104
Q

per the CDC, assess a peripheral IV every ____ to ____ hours an only remove if ____

A

72-96 hours, only if there is an issues

105
Q

in order to provide TPN, the catheter tip needs to end where

A

the distal 3rd end of the SVC or RAJ

106
Q

never advance any external portion of a catheter that has been in contact with the ______ into the insertion site

A

the skin

107
Q

Trans lumbar or transhepatic central lines emptying into the _____ vena cava

A

inferior

108
Q

which central line placements provide the highest risk of infection

A

femoral/inguinal

109
Q

how is pinch off syndrome identified

A

when a patient puts their arm down at their side, the tip of the cath is pinched off but when they lift up their arm, the sensation is releived

110
Q

the development of purulence/pus within 2 cm of an IV line is called

A

exit site infection

111
Q

the development of erythema, tenderness and purulence greater than 2 cm of an IV site is called

A

Tunnel infection

112
Q

the development of erythema over the port, purulent drainage, cellulitis or necrosis is called

A

pocket infection

113
Q

What should IV’s be properly flushed with

A

10mL NaCl 0.9%

114
Q

What method of flushing a catheter prevents a thrombotic occlusion

A

push, pause method where you give 10 short 1mL pushes interrupted by a brief pause to remove solids

115
Q

an IV line should be _______ before and after hooking up and taking off TPN

A

flushed

116
Q

this type of thrombotic occlusion occurs inside the lumen of the IV where you are unable to infuse or aspirate such as a calcium precipitate

A

intraluminal thrombus

117
Q

this type of thrombotic occlusion fully occludes the tip and lumen, looking like a sock over the tip of the IV line

A

fibrin sheath

118
Q

this type of thrombotic occlusion develops a partial occlusion with a tail over the tip identified when you flush saline and try to draw blood but you cannot flush it through or aspirate blood (no draw back)

A

Fibrin Tail

119
Q

this type of thrombotic occlusion occludes around the lumen causing obstruction identified by sweeping at the arm, hard infusation caused from vessel wall injury where fibrin binds to the catheter surface

A

mural thrombus

120
Q

what is used to dissolve acidic precipitates with a pH <6

A

HCL (0.1) N

121
Q

what is used to dissolve lipid precipitates in an IV

A

ehtanol

122
Q

what is used to dissolve alkaline drug precipitates with a pH >7

A

Sodium Bicarb

123
Q

CRBSI stands for

A

Catheter Related Blood Stream Infection

124
Q

what is the most common cause of a hospital acquired inefection

A

CRBSI

125
Q

Ethyl Alcohol Lock Therapy kills ____ and ____ and decreases the adherence of bacteria to prevent CRBSIs

A

bacteria and fungi

126
Q

this type of locking solution decreases the adherence of bacteria to avoid CRBSis

A

ethyl alcohol lock

127
Q

this type of locking solution is not used in the US but is a broad spectrum anti-septic that prevents the growth of bacteria and fungi and does not cause antibiotic resistance

A

Taurolidine

128
Q

Taurolidine is a great locking solution because it will not cause

A

antibiotic resistance

129
Q

the HUB of a catheter can be wiped with _____ before use

A

alcohol wipe

130
Q

the best way to prevent infection is to use ________________ with anti septic technique prior to and during insertion of catheters

A

maximum barrier protection

131
Q

the best anti septic for IV lines is

A

2% aqueous chlorhexidine

132
Q

the lower the number of lumens the _____ the risk for infection

A

lesser

133
Q

avoid ______ to prevent catheter infection as it can increase fungal colonization and cause antibiotic resistance and has not been shown to decrease the rates of CRBSI’s

A

antibiotic ointment

134
Q

a ______ central line has either a single or double lumen, is small in diameter and used in the geriatric or pediatric population

A

Broviac

135
Q

a _______catheter can provide up to 3 lumens

A

Hickman

136
Q

a ____ catheter comes in lumens that are equal in size

A

leonard

137
Q

when checking PICC Placement, an EKG is used to assess _____ waves when the tip reaches the CAJ

A

P waves

138
Q

when the P wave is at ____amplitude, the PICC Is at the correct location

A

maximum amplitude

139
Q

a _____ cuff is attached to a catheter to help secure the IV lime via fibrous tissue ingrowth and creates a barrier to decrease the risk of infection by limiting migration of bacteria

A

surecuff

140
Q

a _____ cuff contains antimicrobials that infuse over time

A

vitacuff

141
Q

this type of IV access is surgically placed into the subcutaneous pocket in the anterior chest or arm as a peripheral vascular access system (PAS) ends in the inferior vena cava and has double lumen ports where you can infuse 2 compatible solutions as the 2 lumens are separated

A

implanted port (PAS)

142
Q

the benefits of a port

A

long term use, minimal alteration in body image, lower infectious rate, can be used anywhere from 1 ,000- 2,000 times and is either single or double lumen

143
Q

this type of IV access is surgically placed into the chest wall ending in the SVC

A

Port a Cath

144
Q

this type of IV access has a valve on the side that only needs to be flushed with normal saline Q 90 days to maintain. It is usually used in patients who get intermittent chemo

A

Groshong Port

145
Q

If a Groshong port is being used currently does it need to be flushed? how often

A

yes every week

146
Q

what is the major cause of morbidity in home PN patients

A

septicemia

147
Q

a very common complication of home PN nutrition is

A

catheter related infection

148
Q

what is the most common cause of re hospitalization for HPN

A

Catheter Related Blood Stream Infections

149
Q

Which venous access devices (VADs) are used for home PN include these 2 lines (when PN needed for >4 weeks)

A

Implantable Port/Tunneled Catheters

Hickman or Broviac

150
Q

a patient undergoing radiation and chemo for cancer in the region of the mediastinum is getting TPN and reports wt loss, and pain/swelling in her neck/right arm. The likely cause of this is

A

a catheter related complication

151
Q

large ____ in PPN must be provided to meet energy needs/protein compared to TPN and therefor not desirable when ___ restricted

A

fluid, fluid

152
Q

when considering PPN suspected use should be for > ___ days

A

5

153
Q

to avoid phlebitis, PPN lines are usually rotated every ___ hours

A

48-72 hours

154
Q

contraindications to PPN are

A

significant malnutrition, severe metabolic stress, marked electrolyte needs, high doses of potassium, fluid restriction, needed for nutrition for >2 weeks and renal/liver compromise

155
Q

the CDC recommends chlorhexidine/silver sulfadiazine or rifampin imprgenanted CVS if catheter is to remain in place > ___ days

A

5

156
Q

enterococci can come from endogenous flora or ______

A

hands of health care workers

157
Q

can candida (yeast) cause sepsis

A

yes

158
Q

the gold standard for the treatment of a diagnosis of CRBSI is catheter removal, however in patients that require _______, catheter salvage is more desired than removal

A

long term IV therapy

159
Q

Central Venous Catheter blood cultures that become positive over ____ hours sooner than peripheral cultures are considered predictive for CRBSI

A

2 hours

160
Q

how can catheter salvage be obtained during suspicion of CRBSI

A

70% ethanol lock solution and systemic abx therapy

161
Q

_______ing catheters are both considered a treatment and prevention for recurrent CRBSi’s

A

locking

162
Q

when the tip of a catheter migrates into the heart chambers ____ can result in cardiac tamponade

A

pericardium puncture

163
Q

____ injury can occur up to months after central line insertion where the patient has paralysis of the diaphragm leading to respiratory distress, decreased air flow to the lungs and decreased respiratory rate

A

phrenic nerve injury

164
Q

symptoms of adverse reaction to lipide injectable emulsions

A

allergic egg reaction, cyanosis, flushing, sweating, nausea, vomiting, headache

165
Q

azotemia in PN can result from

A

excessive protein/amino acid administration

CNSC Exam (32 decks)

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