What is the reason that a nurse can not use a central line
100
Two sites most commonly used for central line cannulation
What is the subclavian vein and the internal jugular vein.
100
Assess for blood return and inability to infuse.
What is occlusion: thrombus, precipitation,
malposition
100
Documentation after a peripheral line insertion
What is date, time and location; gauge; if more than one attempt.
200
Every 7 days
What is transparent catheter dressings are changed with chlorhexadine impregnated sponge days and neutral connectors (caps)or as needed if wet, loose or soiled
200
Infiltration
What is the inadvertent administration of a nonvesicant solution into surrounding tissues.
200
The rationale for post-insertion chest X-rays.
What is a chest x-ray is taken to confirm placement of the line. Those catheters that are not fully
threaded to above the atrium are not considered central lines and cannot be used for Total
Parenteral Nutrition (TPN) or chemotherapy.
200
Exit site has redness, drainage, edema, or tenderness.
What is possible infection: Exit site, tunnel, thrombus, port pocket
200
PICC line monitoring documentation
What is site assessment, external catheter measurement, arm circumference (if signs of complications), dressing changes and patient comments.
300
Face pointing away
What is the position of the patient when changing central line dressings.
300
Upper arms veins and legs
What should be avoided during peripheral insertion
300
Three indications for central line insertion.
What is Indications for central lines include:
1. Administration of Total Parenteral Nutrition.
2. Monitoring Central Venous Pressure.
3. Inability to access peripheral veins.
4. Rapid fluid resuscitation and emergency medications.
5. Administration of incompatible or multi infusions.
6. Insertion of Swan Ganz and Pacer catheter.
7. Temporary access for hemodialysis.
8. Frequent blood sampling.
9. Short and long-term antibiotic therapy.
10. Delivery of treatments such as chemotherapy.
300
Edema at exit site or drainage, increased length of catherter or distended neck veins.
What is dislodgement.
300
Mediport access documentation
What is port location and appearance, skin prep, gauge and length of huber needle, blood return, flush agent and volume, and dressing application.
400
Supplies needed to change a central line
What is a central Line Dressing Change Kit (mask, sterile gloves, chlorhexidine impregnated patch, Chlorhexidine-based cleanser and occlusive, transparent dressing) and Non-Sterile Gloves
400
Small gauge, short catheter in large vein
What is recommended to increase laminar blood flow.
400
Types of central catheters
What is single and multi lumen non-tunneled catheters for temporary use, peripherally inserted central catheters (PICC) are inserted in the arm and advanced into a central
vein, tunneled catheters for prolonged therapy include silastic catheters (Broviac/Hickman) and
implanted ports and hemodialysis catheters for dialysis may be inserted temporarily until permanent access is
available.
400
Patient complains of gurgling sounds, edema of arm and hand on side of insertion, distended neck veins and/or unable to infuse fluids.
What is catheter migration, pinch-off syndrome, port
separation.
400
Charting a complication
What is describe exactly the appearance of the site, who I notified, what I did about it and any patient comments.
500
Other situations when central line dressings should be changed besides the usual 7 days.
What is change the dressing on admission to the unit if the patient has come from an outside facility or
the date of the last dressing change cannot be determined. Gauze dressings are changed to a
transparent dressing. Upon admission, the RN changes the cap(s) on a catheter from an outside
facility.
500
"SAVE That Line!” (Developed by the Association of Vascular Access)
What is SAVE stands for:
S – Scrupulous hand hygiene
A – Aseptic technique during catheter insertion and care
V – Vigorous friction to catheter hub prior to entry
E – Ensuring patency of the device
500
General guidelines for 3-lumen catheter insertion at bedside.
What is
1. Explain the procedure to the patient and provide emotional support.
2. Assemble equipment including an insertion kit with catheter. Sterile barrier equipment (mask,
gown, gloves and drapes) are needed. Plus normal saline IV and an infusion device.
3. Assist physician with the insertion according to hospital policy and procedure. The catheter
should be secured in place and covered with an occlusive dressing.
4. The catheter placement should be confirmed by on X-ray before use. The catheter tip should be
located above the right atrium to prevent arrhythmias. The X-ray will also confirm a
pneumothorax which can be a complication of central line insertion.
5. Finally, continue to monitor the patient and document the catheter placement per X-ray.
500
Skin erosion, hematomas, cuff extrusion, scar
tissue formation over port.
What is loss of viable tissue over implantation, separation of exit site edges, drainage at exit site, redness, edema, contusions and/or tunnelled catheter exposed.
500
Documentation when administering a vesicant
What is type of vesicant, site, complications of pain and any signs and symptoms of complications after infusion.