seminar 9

Question 1

where is a PICC usually inserted

Answer 1

usually inserted into a vein above the ACF (the ditch)

Question 2

should you take blood pressure on the arm where there is a PICC

Answer 2

NO

Question 3

How long are non tunneled CVADS used for

Answer 3

usually left in place less than 7 days but can be used for up to one month

Question 4

how is a non tunneled CVAD inserted into a PT

Answer 4

inserted surgically by a physician and sutured in place since there is a risk for excessive bleeding if it is pulled out

Question 5

where are non tunneled CVADs usually inserted

Answer 5

into the internal/external jugular or subclavian vein

Question 6

What kind of CVAD would be used for long term access

Answer 6

a tunneled CVAD

Question 7

how long is a tunneled CVAD used for

Answer 7

usually used for treatments that are expected to last longer than one year since they can be left in place indefinitely

Question 8

how does a tunneled CVAD stay in place and have a better chance of not becoming infected

Answer 8

since it has a dacron cuff which 3-4 weeks after insertion granulation tissue will grow onto and create a seal and barrier to infection

Question 9

Which CVAD requires a sterile dressing a tunneled or non tunneled

Answer 9

non tunneled since it needs a barrier to protect the site from infection

Question 10

what type of CVAD requires heparin flushing tunneled or non tunneled

Answer 10

tunneled CVAD requires heparin flush

Question 11

where is the end of the catheter located on an IVAD

Answer 11

usually placed in the distal third of the superior vena cava

Question 12

when is a dressing required for an IVAD and what type of dressing

Answer 12

is only required when in use and it can just be an aseptic dressing

Question 13

Does an IVAD require heparin flushing

Answer 13

YES

Question 14

How often does an IVAD need to be heparin flushed when not in use

Answer 14

every 1-3 months

Question 15

Where is the tip of the catheter located in a CVAD

Answer 15

located in the lower third of the superior vena cava

Question 16

what kind of access device would be used for TPN

Answer 16

CVAD

Question 17

how often does the tubing for TPN need to be changed

Answer 17

every 24 hours

Question 18

what extra piece of equipment is required for TPN administration

Answer 18

requires and inline filter to be administered

Question 19

Which lumen should be used when drawing blood from a CVAD

Answer 19

the largest one usually there is a red one that will be for blood

Question 20

how often do you need to access a CVAD if it is running a continuous infusion

Answer 20

need to access the CVAD every hr while its running a continuous infusion

Question 21

How often do you need to access a CVAD if it is saline/heparin locked

Answer 21

once a shift

Question 22

how often do you need to measure the external length of a PICC

Answer 22

needs to be measured at least every 24 hours and with every dressing change

Question 23

what are normal lactate levels for a patient

Answer 23

1-1.5 mmol/L

Question 24

what would lactate levels be if someone was critically ill and needed to be admitted to the ICU

Answer 24

lactate levels above 4 usually indicate the need for critical intervention

Question 25

What volume of air is considered significant if it were to enter a persons circulation

Answer 25

there is no exact number but anything greater than 50 is significant

Question 26

what factors determine the severity of an air embolism

Answer 26

Volume of air rate that it enters clients position at the time of entry

Question 27

what are the three types of CVAD occlusions

Answer 27

-Thrombotic occlusions -Chemical occlusions -Mechanical occlusions

Question 28

what are most chemical CVAD occlusions caused by

Answer 28

usually related to the formation medication or drug precipitate

Question 29

what are signs and symptoms of thrombotic occlusion

Answer 29

-pain and edema around IV site -Engorged peripheral veins (from there being a backup of fluid)

Question 30

what is a mural catheter thrombus

Answer 30

when a clot starts to form around the catheter and attaches to the blood vessel wall

Question 31

what would indicate a intraluminal thrombosis

Answer 31

there would be increased resistance on both aspiration and infusion (since it has made the lumen of the catheter smaller)

Question 32

what would indicate a thrombus with a fibrin tail

Answer 32

infusion would be fine but aspiration may be difficult since the fibrin tail can get sucked back over the lumen of the catheter

Question 33

what would indicate that a fibrin sheath has formed over a catheter

Answer 33

the inability to aspirate or infuse since the catheter has been completely occluded by a thrombus

Question 34

What is catheter infiltration

Answer 34

when a non vesicant (non harmful) fluid leaks out of the vein into the surrounding soft tissue

Question 35

what is catheter extravasation

Answer 35

when a vesicant fluid leaks out of the vein into the surrounding tissue which can cause damage since it is a vesicant

Question 36

what would be some signs and symptoms of CVAD catheter migration

Answer 36

-edema in chest or neck during infusion -client complains of gurgling sound in ear -dysrhythmias

Question 37

can a RN diagnose and administer medication when a client starts to have an anaphylaxis reaction

Answer 37

YES

Question 38

what medication would an RN administer to a PT if they were having an anaphylaxis reaction

Answer 38

Dimenhydramine and epinephrine

Question 39

A client needs an IV line for 6 months of antibiotic therapy, which central line would be most appropriate?

Answer 39

PICC since they are used for more than one month but less than one year

Question 40

Does an IVAD need a heparin flush solution

Answer 40

yes to lock the line

Question 41

how many mL of heparin flush solution does an IVAD need to be locked

Answer 41

usually 5 mL

Question 42

if a client experiences an anaphylactic reaction to an antibiotic given IV through a VAD, the usual two drugs given are

Answer 42

Epinephrine and DiphenHYDRAMINE

Question 43

what is the purpose of placing a client on their left side in trendelenburg position

Answer 43

to move air into the right atrium and right ventricle where it can hopefully escape into the lungs