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NUR 311: IPC > Week 10 - Topic 2: IV Infections > Flashcards

Week 10 - Topic 2: IV Infections Flashcards

1
Q

What are the 5 major HAI?

A

1) Surgical site infection (SSI)
2) Central Line Associated Bloodstream Infection (CLABSI)
3) Ventilator-associated Pneumonia (VAP)
4) Catheter associated UTI (CAUTI)
5) Clostridium difficile associated disease (CDI)

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2
Q

What do most HAI have in common?

A

They are associated with device use

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3
Q

What is a vascular access device useful for?

A 
Hemodynamic monitoring
Rx administration
Transfusion
Blood sampling
Dialysis
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4
Q

When do we use PIV catheters?

A

When infusion therapy is less than 14 days

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5
Q

True or False: Risk of having a bloodstream infection with PIV is low.

A

True

However there is risk for morbidities (ex: thrombus formation) which can lead to infection

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6
Q

True or False: 50% of hospitalized PTs have a PIV.

A

False, 90%

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7
Q

How many attempts are usually made to insert an IV?

A

2-3 attempts –> bad cause increases risk of infection!

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8
Q

True or False: Most PIV last the entire treatment.

A

False

Makes it dangerous cause they have to be reinserted and incr. risk of contamination!

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9
Q

What are the most common PIV Catheter failures?

A

1) Catheter infiltration 24%
2) Catheter occlusion/mechanical failure 18%
3) Catheter related phlebitis 15%
4) Catheter dislodgement 7%
5) Catheter related infection 0.2%

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10
Q

When you are assessing the PIV, what do you LOOK out for?

A 
Redness, swelling
Is dressing intact, clean, dry
Does the line flush without resistance
Can you see injection site (not covered by dressing)
Is PT in pain
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11
Q

When you are assessing the PIV, what do you TOUCH?

A

Skin for warmth, pain, tenderness

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12
Q

When you are assessing the PIV, what do you LISTEN for?

A

For PT complaints (it should not hurt)

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13
Q

Where do you insert PIV?

A

Veins on the dorsal/ventral surfaces of the upper extremities, non-dominant arm

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14
Q

Where do you avoid inserting PIV and why?

A

Areas of flexion such as wrist (dislodgement) and antecubetal fossa (dislodgement + colonized with +++ skin flora so risk of infection)

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15
Q

What are signs of phlebitis?

A

Pain + erythema at access site
Streak formation
Palpable venous cord
Purulent drainage in IV (advanced phlebitis)

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16
Q

When should you replace a PIV (2)?

A

1) When clinically indicated

2) If the line was initially inserted as an emergency

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17
Q

True or False: You should remove a PIV if therapy is completed.

A

True

Don’t leave it on “just in case” PT will need another PIV

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18
Q

What would clinically indicate that a PIV replacement is needed?

A
  • Infiltration
  • Redness
  • Phlebitis
  • Non intact or saturated dressing
  • Warm, palpable cord
  • Tenderness, pain
  • Numbness, tingling
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19
Q

True or False: You should replace an IV every 72-96h.

A

False, unless clinically indicated

Reduce PT’s exposure to unnecessary procedures

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20
Q

In which 5 veins do we place central venous lines (CVL)?

A

1) Subclavian
2) Internal Jugular
3) Brachiocephalic
4) Common Femoral
5) External Iliac

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21
Q

In which blood vessel do we put CVL for neonates?

A

Umbilical artery/vein

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22
Q

What is the risk with using multiple lumen CVL?

A

There more ports of access for bacteria

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23
Q

What would happen if there is vein irritation from the CVL?

A

Fibrin sheath thrombus formation

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24
Q

What are the 7 vascular access catheters (VAD)?

A

1) Peripheral IV catheter
2) Ultrasound-guided peripheral IV
3) Midline catheter
4) Peripherally inserted central catheter (PICC)
5) Non-tunneled central venous catheter
6) Tunneled
7) Implanted port

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25
Q

Which 3 VAD are higher risk due to direct entry into the blood vessels?

A

Midline
PICC
Non-tunneled

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26
Q

Which VAD has the lowest risk of infection due to being completely covered by the skin?

A

Implanted port

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27
Q

What is the difference between a PICC and a midline catheter?

A

PICC: catheter ends in the superior vena cava
Midline: catheter ends near the axilla

Both are placed in the same veins (basilic, cephalic or brachial)

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28
Q

What is CLABSI?

A

Central line associated bloodstream infection

29
Q

Which organisms are most involved with CLABSIs?

A

Skin flora such as:

  • Coagulase-negative Staph* (also known as Staph epiderdemis)
  • Staph aureus*
  • Candida
  • Enteric gram - bacilli
  • Pseudomonas aeurignosa

*Form the most biofilms

30
Q

True or False: Skin can never be sterilized.

A

True

Bacteria reside in hair follicles and sebaceous glands and are unreachable by antiseptics

31
Q

What is the danger with unstable, moving catheters?

A

The biofilm on them can dislodge and infect the bloodstream

32
Q

From where do the contaminants from CLABSI come from?

A

1) Skin (PT, HCW, contaminated desinfectant) 60%
2) Hematogenous (from distant infection) 28%
3) Contaminated catheter hub (PT or HCW skin flora) 12%
4) Contaminated infusate (fluid, medication) <1%

33
Q

What are the two types of infections associated with intravascular catheters?

A

1) Skin infection (cellulitis and phlebitis)

2) Bloodstream infection/bacteremia/septicemia

34
Q

When should you perform hand hygiene during insertion of VAD?

A

BEFORE palpating insertion site

35
Q

True or False: You can palpate the PT skin area after applying the antiseptic.

A

False

36
Q

True or False: When inserting a CVL, we cover the PT’s thorax area to avoid contamination.

A

False, we cover PT from head to toe

37
Q

List the the veins from most to least risk of infection due to skin colonizatin.

A

Femoral > Jugular > Subclavian

38
Q

True or False: You have a higher risk of infection from inserting an IV in the antecubital space vs the femoral vein.

A

False
Antecubital space = 10 CFU/cm2
Femoral vein = 1000-10,000 CFU/cm2

39
Q

What do you use for skin antisepsis before catheter inserting and dressing changes?

A

Chlorhexidine 2-4% in 70% isopropyl alcohol

40
Q

How do you apply skin antisepsis?

A

Apply using back-and-forth friction rub for at least 30s
Do not wipe or blot
Allow to dry

41
Q

True or False: You can use tincture of iodone, iodophor or 70% alcohol for skin antisepsis.

A

True, but they are no ideal

42
Q

What happens if you apply the catheter/dressing before allowing the antiseptic to dry?

A

Skin irritation (redness)

43
Q

What are some methods to stabilize IV lines?

A

Sutures (old)

Adhesive securement devices (new)

44
Q

What are the guidelines of Santé Quebec’s Maintenance bundle?

A
  • Check line necessity daily and remove unnecessary line
  • Check entry site for signs of infection daily and at every dressing change
  • Dedicate lumen for TPN
  • Disinfect each lumen hub every time you access it aseptically
45
Q

When can you put a transparent dressing?

A

When the dry dressing is intact and non-soiled

46
Q

How often do you change dressings?

A

Dry dressing: 24h after the insertion or if visibly soiled, unstuck, damp

Transparent dressing: every 7 days or more

47
Q

What can make the dressing fall off or move the line?

A
  • Excess hair
  • Skin moisture
  • Areas of flexion
48
Q

How often should you change the injection cap and tubing?

A

Every 96 h or

1 week if not in use or

Immediately if broken, occlusion, visible blood, post-administration of blood

49
Q

How often should you scrub the hub to avoid contamination?

A

15 sec at least

50
Q

In terms of IPC, what must you do when you connect/disconnect an IV line?

A

Remove the cap
Clean the connection for 15 sec before disconnecting
Disconnect
Clean the hub before you reconnect

51
Q

Can you reuse dead-end caps?

A

No

52
Q

What are 4 high risk fluids that can contaminate the line?

A

1) Parenteral nutrition (esp. amino acids and lipiiid emulsions)
2) Blood/blood products
3) Multidose vials (many people use it)
4) Inpatient unit prepared mixed IV solutions (as opposed to prepared in pharmacy)

53
Q

True or False: You can’t draw blood from the same port for TPN?

A

True

You also can’t administer drugs, or connect stopcocks

54
Q

True or False: You can draw blood from CVLs.

A

True

But its not ideal because contamination rates are much higher

55
Q

John’s physician orders a CVL blood draw. Do you (the nurse) go do it?

A

NO
You don’t just go immediately do it. You must a validate the need for a CVL blood draw and ask if a line infection is suspected or if there is a plan to remove the line after the draw.

56
Q

When you do a CVL blood draw, how many bottles do you collect?

A

4 bottles (2 sets of 2)

1 set of aerobic and anaerobic
1 set of central and peripheral done at different times (to know if lumen contamination)

57
Q

Why do we draw multiple sets of blood?

A

To exclude the possibility contamination

58
Q

How much blood do we collect in each bottle of a draw?

A

10 ml per bottle for adults

59
Q

True or False: It is best to draw blood from a PICC rather than do venipuncture.

A

False

PICCs have the smallest diameter and the greatest risk for occlusion (biofilm/blood clots) and hemolysis (77% vs 3.8% for venipuncture)

60
Q

Where do you draw blood from on a CVAD?

A

Directly from the hub

with a sterile transfer device and replace with new needleless connecter

61
Q

What don’t you do when you draw blood from a CVAD (3)?

A

Don’t draw….

1) With a vacutainer directly on the hub
2) From the tube
3) From a 3 way-stop-cock

62
Q

You are about to prepare medication for your PT. What must you do with the vial?

A
  • Check if its multidose or single use
  • Expiration date
  • Label it if you open it
  • Check for turbidity, leaks, cracks
  • Clean the rubber diaphragm with 70% alcohol before accessing
63
Q

What are symptoms that highly suggest line sepsis?

A
  • Abrupt onset of fever and shock
  • Dramatic improvement after removal of device
  • Inflammation or pus at site
64
Q

True or False: Visible blood on the catheter is normal.

A

FALSE

65
Q

If someone has bacteremia, what other complications can they develop (4)?

A

1) Endocartitis
2) Myocarditis
3) Pericarditis
4) Osteomyelitis

66
Q

True or False: A Dacron cuff is part of a totally implantable central venous catheter.

A

False, it is part of the tunneled CVL

67
Q

True or False: Flushing the catheter with heparin will remove biofilms.

A

False, it will reduce biofilm formation by preventing blood clots, but not remove it.

68
Q

How do biofilms form?

A

Host components (ex: protein and fibrin from coagulation embedded in polysaccharid matrix / urinary components, proteins, electrolytes for urinary catheters) cause the attachment of bacteria, cell division and formation of extracellular matrix to form a biofilm on the plastic catheter

NUR 311: IPC (17 decks)

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