Central Line Dressing & Blood Draws
Describe 3 benefits of a semipermeable dressing
Allows visual inspection
Secures the catheter
Requires less frequent changes
Describe 2 advantages of your patient receiving an implanted port over a tunneled central venous catheter
Improved body image (low visibility of port)
Patient comfort
Local catheter site care and dressing not needed when not in use
True or False: Access an implanted port requires sterile technique.
TRUE!
What is the ideal vein for PICC line placement?
When hanging a piggy back infusion, which bag of fluids should be lower using the blue hook?
Primary bag of fluids should be lower using the blue hook
What is the first action the nurse should take if the needleless connector becomes disconnected from the lumen?
Clamp the lumen
Your patient was recently diagnosed with cancer and will be receiving chemotherapy over the next 4 months, what central venous catheter would you expect to be placed?
The nurse is preparing to access the port of a patient with a high BMI. What should the nurse do differently given this information?
Utilize a longer non-coring needle
Describe 2 steps the nurse should take to prevent infection when changing a central venous catheter dressing
Have the patient wear a mask or turn head to side
Have the practitioner wear a mask
Utilize sterile technique
Clean beginning at the site of insertion and move away
Allow to dry completely
Name 3 locations an IV should not be inserted into for an adult patient
Legs
Feet
Scalp
Restricted extremity
What amount of fluid should be flushed to reduce the risk of catheter damage when flushing a central venous catheter?
Flushing with at least 10mL of normal saline or 2x the volume within the system
Your patient is having a PICC line placed this afternoon. What vein would you expect to be used in this procedure for best results?
Basilic vein
What amount of time should pass following the placement of an implanted port?
It can be used immediately
Describe 3 pieces of education you should provide your patient with a central venous catheter
Keep clamps closed when it is exposed to air
Cover the site when bathing or showering
Avoid sports
Keep sharp objects away from the catheter to prevent blood backflow or air embolism
Avoid swimming
Notify your provider of any upper extremity soreness
What is the best way to prevent an IV on an infant from becoming dislodged?
Utilized a joint stabilization device along with your semi-transparent dressing
Under what circumstances should central venous catheters be flushed?
Before and after medication of administration
After blood sampling
Upon discontinuation of an infusion
Your patient is receiving frequent antibiotics for 19 days and is a difficult IV start. What CVC would you expect to be inserted?
PICC Line
What volume of blood should be wasted when obtaining a blood sample from an implanted port?
Per facility policy
What documentation is essential following removal of a PICC line?
Length of the catheter
AB+
What is the primary purpose for flushing a central venous catheter after a blood draw?
Decrease the risk of thrombotic catheter occlusion
Describe 4 reasons your patient may have a PICC line placed instead of a peripheral IV.
Long term antibiotics - infusions can be frequent, prevents need for new IV site each session
Frequent lab draws
No peripheral access - some patient have veins that are not easy to access
High osmolarity solutions
TPN
Trauma
How often should the non-coring needle of an implanted port be replaced?
Every 7 days
What step should the nurse take if the patient begins to develop shortness of breath, coughing, and cyanosis with a central venous catheter?
Place the patient in Trendelenburg
Describe the steps to administering a medication IV push that is not compatible with the running solution
Stop the pump
Flush with normal saline
Administer the medication
Flush with normal saline
Restart the pump