CVAD

Question 1

3 Types of CVADs

Answer 1

1. Non-tunneled
2. Tunneled
3. Port-a-cath

Question 2

What is a PICC line

Answer 2

a Peripherally inserted central catheter

Question 3

Which of the 3 types is at a higher risk of infection

Answer 3

Non-tunneled

Question 4

With Non-tunneled and Tunneled CVADs, how are they removed?

Answer 4

Non-tunneled- nurses can take out
Tunneled- must be surgically removed

Question 5

Out of the 3 types of CVADs, how long do they normally stay in?

Answer 5

Non-tunneled: 6wks
Tunneled: >6wks
Port-a-cath: months to years

Question 6

Which veins in the arm are used for PICC

Answer 6

The Basilic or cephalic vein

Question 7

Who can place PICC lines? (2)

Answer 7

The PICC team or IR

Question 8

What cannot be done on an arm with a PICC line (2)

Answer 8

Phlebotomy or blood pressures

Question 9

What CVADs type uses a Dacron cuff

Answer 9

A tunneled CVAD

Question 10

What does a Dacron cuff help? (2)

Answer 10

It helps secure the catheter and helps prevent infection

Question 11

Which CVAD type is sutured in?

Answer 11

The tunneled and non-tunneled

Question 12

Which type of CVAD is the least restrictive ?

Answer 12

Port-a-cath

Question 13

What type of needle is needed for a Port-a-cath

Answer 13

A Huber Needle

Question 14

How do you confirm a CVAD Placement

Answer 14

X-ray

Question 15

Where was the catheter tip ended?

Answer 15

The superior vena cava

Question 16

What are 3 things to inspect the insertion site for?

Answer 16

S/S of infection
Displacement
Sutures

Question 17

What is the distal lumen used for? (4)

Answer 17

Blood draws, blood infusions, meds, Central venous pressures (CVP)

Question 18

What is the proximal lumen used for? (3)

Answer 18

IV fluids, meds, blood draws

Question 19

What is the medial lumen used for? (1)

Answer 19

TPN

Question 20

What are some complications of CVADs ?(7)

Answer 20

• infections (CLABSI): Central Line-associated Bloodstream infection
• Pneumothorax: Air in the pleural space outside the lung
• Air embolism:- Air entering the circulatory system
• Occlusion- Lack of blood return or sluggish flow
• Thrombosis: Clot that blocks the catheters lumen
• Catheter Rupture: May be caused by excessive force used while flushing
• Catheter Migration : Catheter displacement

Question 21

S/S of CLABSI (8)

Answer 21

-Redness
-Drainage
-Swelling
- Discomfort at insertion site
- Fever
- Chills
-tachycardia
- Leukocytosis

Question 22

S/S of Pneumothorax (7)

Answer 22

• dyspena
• Hypoxia
• Tachycardia
  -Restlessness
  -cyanosis
  -chest pain
  -decreased breath sounds

Question 23

Nursing interventions for Pneumothorax (4)

Answer 23

• Monitor Vs
  -Administer O2
• Notify Dr., CN, RRT
• Prepare for chest tube if indicated

Question 24

S/S of Air embolism (6)

Answer 24

Dyspnea, chest pain, tachycardia, hypotension, anxiety, and nausea

Question 25

Nursing Interventions for air embolism (4)

Answer 25

- Keep lumen clamped - Administer oxygen, monitor Vs, Pulse ox - Place patient on left lateral side in trendelenburg position - stay with the patient and notify Dr, CN, and RRT

Question 26

Nursing interventions for catheter occlusion (6)

Answer 26

- Take deep breaths/ cough - Raise arms overhead and reposition arm on sam side as the catheter - Have patient sit up/stand up - change positions in bed - Place in trendelenburg - Administer alteplase

Question 27

When do you assess the CVAD site

Answer 27

Before any interventions

Question 28

When do you scrub the hub for?

Answer 28

15 seconds

Question 29

When do you scrub the hub?

Answer 29

Before you access the lumen

Question 30

What do you program a CVAD infusion to

Answer 30

A pump

Question 31

What mL syringe do you use to flush a lumen

Answer 31

A 10 ml syringe

Question 32

When do you flush the lumens? (3)

Answer 32

After every medication After every blood draw Every shift

Question 33

when do you do a dressing change for a CVAD? (3)

Answer 33

24 hour post-insertion & every 7 days or PRN

Question 34

When do you change the Max-Zero caps?(2)

Answer 34

Every 7 days or PRN

Question 35

What angle should the HOB be for a dressing change be

Answer 35

30

Question 36

What must you do before performing a dressing change

Answer 36

Assess the site, lumens, and clamps

Question 37

Steps to Removing a CVAD catheter (8)

Answer 37

1. Get a Dr.’s order, CVAD kit, Suture removal kit, petrolem based gauze 2. Clip sutures 3. Hold Breath & Pull line out 4. Hold pressure 5 minutes or until bleeding stops 5. Apply Petroleum gauze to insertion site 6. Cover with occlusion dressing & leave on for 24 hours 7. Remain supine at least 30 mins 8. Document + patient teaching

Question 38

PICC line removal steps (9)

Answer 38

1. Get a Dr.’s order, CVAD kit, Suture removal kit, petrolem based gauze 2. Clip sutures 3. Hold Breath & Pull line out measure catheter length of PICC line 4. Hold pressure 5 minutes or until bleeding stops 5. Apply Petroleum gauze to insertion site 6. Cover with occlusion dressing and 4x4 gauze. Cover that with coban & leave on for 48 hours. 7. Remain in supine for 30 mintues 8 document and patient teach 9. Monitor for complications