Term
| What is the leading complication associated with peripheral access? |
|
Definition
|
|
Term
| What are the symptoms of infusion phlebitis? |
|
Definition
- Pain
- Erythema
- Tenderness
- Palpable cord
|
|
|
Term
| What are some of the variables affecting risk of venous thrombosis? |
|
Definition
- Catheter material
- Size
- Operator skill
- Infusate
- Duration of infusion
|
|
|
Term
| What is the single most significant risk factor for phlebitis? |
|
Definition
| Duration of catheterization |
|
|
Term
| How frequently should peripheral catheters be rotated? |
|
Definition
| The traditional frequency was 48 to 72 hours, but recently it has been proposed that they should only be changed when clinically indicated |
|
|
Term
| How quickly should the peripheral cannula be removed after development of phlebitis? |
|
Definition
| As soon as phlebitis develops |
|
|
Term
| Where should the replacement catheter be placed when replacing for phlebitis? |
|
Definition
| The replacement catheter should be placed at some distance from the phlebitis, preferably in the other limb |
|
|
Term
| Which type of venous access device (peripheral vs central) has the lowest risk of catheter-related infections? Why? |
|
Definition
| Peripheral devices have the lowest risk of infections due to lower dwell time and possibly poor reporting |
|
|
Term
| What distinguishes central vs peripheral access? |
|
Definition
| A peripheral catheter is defined as one in which tip position is outside the central vessels (inferior or superior vena cava or right atrium) |
|
|
Term
| What are common sites of venipuncture for central access? |
|
Definition
- Subclavian
- Jugular
- Femoral
- Cephalic
- Basilic
Locations of each located on page 267 |
|
|
Term
| What are the primary indications for central venous access? |
|
Definition
- Chemotherapy
- Antibiotics
- PN
|
|
|
Term
| What advantages does central access offer in terms of what drugs can be administered? |
|
Definition
| Drugs which are administered centrally are not limited by pH, osmolality, or volume (small or large). Also, the risk of extravasation (leakage into surrounding tissues) of vesicant drugs is reduced. |
|
|
Term
| What are the three types of central venous access devices? |
|
Definition
- Tunneled
- Nontunneled
- Implanted
|
|
|
Term
| When are nontunneled CVADs typically used? |
|
Definition
| In the acute care setting for therapies of short duration |
|
|
Term
| What is used to prevent dislodgement and contamination of nontunneled CVADs? |
|
Definition
| Sutures or a securement device are placed at the exit site, and a sterile dressing is used |
|
|
Term
| Are routinely scheduled catheter exchanges recommended to prevent catheter-related infections for nontunneled CVADs? Why? |
|
Definition
| No. Routine exchanges result in higher rates of infection |
|
|
Term
| Are PICC lines classified as a tunneled or nontunneled catheter? |
|
Definition
|
|
Term
| Who can place a PICC line? |
|
Definition
| Nurses and physicians with specialized training |
|
|
Term
| What are some of the advantages of tunneled catheters? |
|
Definition
- Ease of self-care by patient
- Decreased risk of dislodgement
- Ability to repair external lumen in the event of catheter breakage
|
|
|
Term
| What type of maintenance is required for ports? |
|
Definition
| Ports do not require routine site care when not in use and should be maintained with a monthy heparin flush |
|
|
Term
| What type of patient is ideal for use with a port? |
|
Definition
| Those who receive infrequent IV therapies, such as those receiving intermittent chemotherapy |
|
|
Term
| What are examples of central access devices? |
|
Definition
- Percutaneous nontunneled central catheter
- Tunneled cuffed catheter
- PICC (nontunneled)
- Implanted port
|
|
|
Term
| What are examples of peripheral access devices? |
|
Definition
- Peripheral cathers
- Midline catheters
- Midclavicular catheter
|
|
|
Term
| How does length of use affect choice of peripheral access device? |
|
Definition
| Peripheral catheters have relatively short lifespan. Midline catheters can last for 2-4 weeks. Subclavicular catheters can be used for 2-3 months. |
|
|
Term
| Which type of CVAD has the highest risk of infection? |
|
Definition
| Percutaneous nontunneled central catheter |
|
|
Term
| How are tunneled cuffed catheters placed and removed? |
|
Definition
| Tunneled cuffed catheters require an operating room or specialized room for placement. They also require a small procedure for removal. |
|
|
Term
| What is a potential disadvantage to PICC lines? |
|
Definition
| Self-care can be difficult because dressing changes require both hands |
|
|
Term
| What are the components of a vascular access selection/preop assessment process? What is the purpose of such an assessment? |
|
Definition
| A vascular access history and focused physical exam can decrease the risk of insertion-related complications |
|
|
Term
| What factors are associated with failure of placement of a CVC in the subclavian vein? |
|
Definition
- Prior surgery or radiation in the region
- BMI >30 or <20
- Previous catheterization
|
|
|
Term
| What should a physical exam consist of prior to placement of a vascular access device? |
|
Definition
Physical exam should focus on identifying any lesions, tumors, previous surgical procedures, venous abnormalities, or breaks in skin integrity near the intended placement site
|
|
|
Term
| What types of medications should be screened prior to placement of a vascular access device? |
|
Definition
| The medication history screens for drugs that could impact coagulation status such as aspirin, NSAIDs, warfarin, or heparin |
|
|
Term
| What should be done if a patient is on anticoagulants or antiplatelet medications prior to placement of a vascular access device? |
|
Definition
| The medications should be held with a possible transition to low-molecular weight heparin based on individual risk of thromboembolism |
|
|
Term
| What can be performed to determine catheter patency? |
|
Definition
| Venous duplex ultrasonography or venous angiography |
|
|
Term
| What can be done to minimize risk of CVC-related infection and decrease placement complications? |
|
Definition
| The use of a subclavian approach and choosing a device with a minimal number of ports or lumens can minimize CVC-related infection and decrease placement complications |
|
|
Term
| What are contraindications to long-term CVC placement? |
|
Definition
- Sudden clinical deterioration with a change in treatment plan
- New unexplained fever
- Absolute neutropenia (WBC <1000)
- Low platelets should also be considered
|
|
|
Term
| What has a greater impact on minimizing infection risk during CVC placement: the setting (i.e. operating room vs. bedside) or the use of barrier precautions? |
|
Definition
| The use of maximal barrier precautions during CVC placement is given strong emphasis as a recommended placement |
|
|
Term
| What are two common techniques for CVAD insertion? |
|
Definition
| The percutaneous approach and venous cutdown |
|
|
Term
| What is the percutaneous approach to CVAD placement? |
|
Definition
- Locating anatomic landmarks
- Cannulating the vessel
- Inserting a guidewire followed by an introducer
- Threading the catheter through the sheath of the introducer and advancing it into central circulation
|
|
|
Term
| What are risks associated with percutaneous approach? Which is the most common? |
|
Definition
| Pneumothorax, arterial puncture, catheter pinch-off are risks. Catheter pinch-off is the most common |
|
|
Term
| How is a venous cutdown approach conducted? |
|
Definition
| The vein is dissected, and a venotomy allows for direct visualization of the vessel while inserting the catheter |
|
|
Term
| What is the advantage of the venous cutdown approach? |
|
Definition
| It virtually eliminates the risk of pneumothorax |
|
|
Term
| On which veins can the venous cutdown approach be used? |
|
Definition
| Cephalic, external jugular, internal jugular |
|
|
Term
| What is an issue with verification of catheter placement and absence of pneumothorax using a post-procedure chest x-ray? |
|
Definition
| A pneumothorax is sometimes not identified on a chest x-ray, but only on the repeat chest x-ray when the patient is symptomatic |
|
|
Term
| What role can ultrasound play in CVC placement? |
|
Definition
| The use of ultrasound as an adjunct to CVC placement improves overall placement rates as well as decreases complications associated with placements |
|
|
Term
| How should catheter placement sites be assessed on a daily basis? |
|
Definition
| They should be palpated daily for tenderness and visually inspected for signs of local infection |
|
|
Term
| How frequently should the catheter exit site be cleaned, and what should be used? |
|
Definition
| The site should be cleaned daily with alcohol, iodine, or chlorhexidine (with chlorhexidine being the most effective). A combination of chlorhexidine and alcohol can also be used, and this has been shown to be very effective. |
|
|
Term
| Is the use of antibiotic ointments at the catheter insertion site recommended? Why? |
|
Definition
| No due to the change in normal bacterial flora and the emergence of resistant bacteria or fungi. Some ointments have shown benefit in high-risk patients such as the critically ill and those on hemodialysis. |
|
|
Term
| How should catheter exit sites be covered? Which is the most effective? |
|
Definition
| Sterile gauze or transparent dressings should be used to cover the exit site. No difference in efficacy between these two. Once healed, some cuffs can be cleaned with soap and water with no dressing. |
|
|
Term
| How frequently should CVCs be flushed? |
|
Definition
| Most should be flushed daily, although ports can be flushed every 4 weeks |
|
|
Term
| What are the guidelines for CVC hub care (i.e. at the exit site?) |
|
Definition
| Vigorous scrubbing with an antiseptic may be preferable, although there is lack of agreement on the optimal agent |
|
|
Term
| How should catheters be flushed to maintain patency? |
|
Definition
| Routine use of a heparin flush decreases thrombotic occlusions. The volume of the flush solution should be twice the volume of the catheter. |
|
|
Term
| What type of catheters do not require use of a heparin flush? |
|
Definition
| Split-valve catheters do not require use of a heparin flush secondary to their design |
|
|
Term
| Why are catheters anchored? |
|
Definition
| Anchoring the catheter prevents migration and loss of access. It also prevents subtle movements of the catheter tip against the wall of the blood vessel, which can create irritation and promote thrombosis formation |
|
|
Term
| What are common methods of anchoring catheters? |
|
Definition
| Common methods of anchoring catheters include sutures, sterile tape, and surgical strips |
|
|
Term
| How is French size calculated? |
|
Definition
| French size is the circumference of the outer diameter of the catheter in millimeters |
|
|
Term
| What is the advantage of multi-lumen catheters? |
|
Definition
| They allow for simultaneous infusion of multiple solutions or incompatible drugs |
|
|
Term
| What is the purpose of catheter cuffs? |
|
Definition
| They serve as subcutaneous anchors and mechanical barriers |
|
|
Term
| What is the most common type of material used for long-term indwelling vascular access devices? Why? |
|
Definition
| Silicone elastomer because of its elasticity and softness (resulting in less damage to the vessel intima), low inflammatory potential, low surface adherence for microbial populations, and chemically inert properties with reduced platelet adherence |
|
|
Term
| What is a disadvantage of using silicone elastomer for long-term indwelling vascular access devices? |
|
Definition
| Serum proteins will adsorb to the surface, making fibrin sleeve formation a common complication |
|
|
Term
| When should use of an antimicrobial catheter be considered? |
|
Definition
| Antimicrobial catheter should be considered when other strategies have failed to reduce risk of infections |
|
|
Term
| What are the most common complications observed with vascular devices? |
|
Definition
| Infections are the most common complication, followed by catheter occlusion, thrombosis, and breakage |
|
|
Term
| What are the two most likely sites for infectious catheter contamination? |
|
Definition
| The skin entrance site and the hub |
|
|
Term
| How are infections treated if they occur at the exit site vs the tunnel/pocket? |
|
Definition
| Exit site infections can be treated through warm compresses, daily site care, and oral antibiotics. Most other infections require catheter/port removal. |
|
|
Term
| What is the recommendation for antibiotic locks to prevent infection? |
|
Definition
| The CDC recommends that the practice be limited to patients with long-term catheters who have a history of infections |
|
|
Term
| What is the recommended care bundle for central lines? |
|
Definition
- Hand hygeine
- Maximal barrier precautions
- CHG skin antisepsis
- Optimal catheter site selection
- Daily review of line necessity w/ prompt removal of unnecessary lines
|
|
|
Term
| What is the most common noninfectious complication of central line access? |
|
Definition
|
|
Term
| What are risk factors associated with thrombus occlusion of catheters? |
|
Definition
- More than one insertion attempt
- Ovarian cancer
- Previous CVC insertion
|
|
|
Term
| What are symptoms of vascular obstruction? |
|
Definition
- Neck vein distension
- Edema
- Tingling or pain over the ipsilateral arm or neck
- Tight feeling in the throat
- Prominent venous pattern over the anterior chest
|
|
|
Term
| What are the leading causes of nonthrombotic intraluminal occlusions? |
|
Definition
- Drug-heparin interactions
- PN formulations with inappropriate calcium-phosphorous
- Lipid residue
|
|
|
Term
| What can be done to prevent nonthrombotic intraluminal occlusions? |
|
Definition
| Normal saline flush between all IV medications, infusions, and heparin |
|
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