Week 1: CVAD/PICCs

Question 1

CVAD indications

Answer 1

IV fluid, blood product, medications, irritants, vesicants, pH solutions, hypertonic administration
Obtain venous blood samples
Monitor CVP pressure
Provide pulmonary artery catheters or transvenous pacemaker
Provide hemodialysis access
Consider length of time client needs IV access

Question 2

Where does a PVAD sit?

Answer 2

In the periphery

Question 3

Where does a CVAD sit?

Answer 3

SVC

Question 4

Where is a PVAD inserted

Answer 4

Hand to elbow distal veins of the arm or in the foot

Question 5

Where is a CVAD inserted?

Answer 5

Jugular, cephalic, basilica, brachial, subclavian, femoral

Question 6

How long is dwell time for a PVAD?

Answer 6

Q72-96hrs or PRN

Question 7

How long is dwell time for a PICC?

Answer 7

Up to 1 year (6 months is common)

Question 8

How long is dwell time for a nontunneled CVAD

Answer 8

1 week

Question 9

How long is dwell time tunneled CVAD

Answer 9

up to 3 years

Question 10

How long is dwell time for an IVAD

Answer 10

up to 5 years or # of punctures

Question 11

What is classified under a CVAD?

Answer 11

PICC
nontunneled
tunneled
IVAD

Question 12

What types of infusions occur with CVAD

Answer 12

chemotherapy, long term, TPB, increased osmolality, or decreased pH, higher irritant, cost consideration

Question 13

What rate of infusion can CVAD take?

Answer 13

2-3L/minute

Question 14

Who can insert a PVAD

Answer 14

RN, LPN - some places doctor, anesthetist, IV nurse

Question 15

Who can insert a PICC?

Answer 15

IV nurse

Question 16

Who can insert CVADs?

Answer 16

Surgeon while pt is under anesthetic

Question 17

Can you do blood sampling on a CVAD?

Answer 17

Yes - ONLY if needed

Question 18

Can home IV therapy be on a CVAD?

Answer 18

Yes - PICC, port a Cath, hemodialysis line

Question 19

PVAD/CVAD Complication risks

Answer 19

infection, phlebitis, thrombophlebitis, fluid overload, arterial puncture, hemorrhage, extravasation

Question 20

What are additional CVAD complications

Answer 20

catheter embolism, pneumothorax, hemothorax, arrhythmia, Horners syndrome

Question 21

How much does a PVAD cost?

Answer 21

under 200 even if multiple attempts

Question 22

How much does a CVAD cost?

Answer 22

can be 1500 and more

Question 23

How often is a PVAD dressing changed?

Answer 23

PRN, flush per shift if not infusing

Question 24

How often is a CVAD dressing changed?

Answer 24

Q7 days and prn

Question 25

How often is a CVAD flushed?

Answer 25

Q12 hrs (Q24 with home care)

Question 26

Where is a PICC inserted?

Answer 26

in the peripherary in the cephalic, basilica, or median cubital vein above the ACF

Question 27

What does a power injectable do?

Answer 27

Allows power injection of contrast media for scans

Question 28

How fast can power injectables infuse

Answer 28

5mL/sec (usually all 18 gauge)

Question 29

What are nontunneled lines used for?

Answer 29

Short term and emergent therapy

Question 30

What is a Dacron cuff?

Answer 30

placed under the skin just above the exit site, granulation tissue grows onto the cuff and creates a seal

Question 31

What does an IVAD consist of?

Answer 31

a reservoir, a hollow metal disk with a self sealing membrane, and a catheter

Question 32

What kind of line is a hemo line

Answer 32

tunneled central line

Question 33

what do catheters positioned perpendicular to the vein wall have an increased risk for

Answer 33

vessel erosion, hydrothorax, hydromediastinum, tamponade, and extravasation

Question 34

Steps before administering medication through a CVAD

Answer 34

1. Check parenteral policy prior to administration 2. Need to check compatibility of the medication 3. Check patency of the CVAD 4. Flush before and after a medication 5. Flush between medications

Question 35

What is required to administer TPN through a CVAD?

Answer 35

An in line filter

Question 36

What is CVP?

Answer 36

the pressure measured in the vena cava near the right atrium

Question 37

What are normal CVP ranges

Answer 37

3 to 8 cm H2O