Catheter Occlusion Management
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Questions and Answers

What serious complications can arise from forceful flushing of a severely occluded CVAD?

  • Increased blood flow
  • Catheter breakage (correct)
  • Catheter-related bloodstream infections (correct)
  • Decreased catheter longevity

    • Which of the following is a primary cause of non-thrombotic occlusion in CVAD?

  • Insufficient catheter length
  • Allergic reactions to medications
  • Air embolism formation
  • Lipid accumulation in the catheter lumen (correct)

    • Which method is recommended to ensure no residual infusate remains within the catheter?

  • Flushing only after medication administration
  • Push-Pause technique (correct)
  • Continuous flushing with heparin only
  • Routine flushing protocols without pause

    • What is the consequence of inadequate maintenance and care of CVADs?

    <p>Potential need for catheter removal</p> Signup and view all the answers

    What is an appropriate treatment for a mineral/acidic precipitate in a catheter with a low pH?

    <p>Administration of hydrochloric acid (HCl)</p> Signup and view all the answers

    Which of the following indicates a potential catheter occlusion?

    <p>Difficulty or inability to flush</p> Signup and view all the answers

    Which flushing protocols are recommended after administering medication if saline is incompatible?

    <p>SASH: Saline, Administer medication, Saline, Heparin</p> Signup and view all the answers

    What is advised for routine flushing in CVAD maintenance?

    <p>Proactive maintenance and early detection</p> Signup and view all the answers

    What is a recommended flush agent if saline is incompatible with a medication?

    <p>Use of a recommended flush agent</p> Signup and view all the answers

    What should be included in the evaluation of a CVAD experiencing occlusion?

    <p>Review of infusates received in the past 24 hours</p> Signup and view all the answers

    What is a possible result of catheter movement or inadequate device securement?

    <p>Sluggish or absent blood return may occur</p> Signup and view all the answers

    Which technique should be employed to avoid catheter occlusion during insertion?

    <p>Utilize ultrasound guidance for placement</p> Signup and view all the answers

    What long-term complication can arise from thrombosis associated with catheter occlusion?

    <p>Post thrombotic syndrome</p> Signup and view all the answers

    What should NOT be done to prevent catheter occlusion?

    <p>Wear restrictive clothing to enhance catheter positioning</p> Signup and view all the answers

    Which of the following is a symptom of catheter occlusion?

    <p>Erythema at the insertion site</p> Signup and view all the answers

    What is one recommended action if a catheter is suspected to be occluded?

    <p>Evaluate the catheter for signs of mechanical obstruction</p> Signup and view all the answers

    What is the first step in managing a suspected catheter occlusion?

    <p>Assess the symptoms and catheter condition</p> Signup and view all the answers

    Which statement accurately reflects a method to prevent catheter occlusion?

    <p>Ensure proper vessel selection and catheter size</p> Signup and view all the answers

    What is the maximum catheter to vein ratio (CVR) to prevent thrombotic occlusion?

    <p>45%</p> Signup and view all the answers

    What should be monitored as a potential symptom indicating catheter occlusion?

    <p>Collaterals on the affected limb</p> Signup and view all the answers

    Which of the following is a symptom of thrombotic occlusion?

    <p>Difficulty or inability to infuse</p> Signup and view all the answers

    Which condition might require catheter removal due to occlusion?

    <p>Progressive symptoms occur requiring examination</p> Signup and view all the answers

    What is the role of Alteplase in treating thrombotic occlusions?

    <p>It is the only FDA cleared thrombolytic agent for dysfunctional CVADs</p> Signup and view all the answers

    Which factor should be checked before instilling a thrombolytic agent like Alteplase?

    <p>Tip malposition and mechanical factors</p> Signup and view all the answers

    What technique should be employed when inspecting the external length of the catheter for kinking?

    <p>Aseptic technique</p> Signup and view all the answers

    What should be done if resistance is felt while flushing a catheter?

    <p>Stop flushing and evaluate for obstruction</p> Signup and view all the answers

    Which of the following is not a cause of thrombotic occlusion?

    <p>Improper administration of intravenous medications</p> Signup and view all the answers

    What can lead to catheter dysfunction that cannot be resolved without removal?

    <p>Improper use and inadequate maintenance care</p> Signup and view all the answers

    Why should chest radiography be indicated when assessing a catheter?

    <p>To confirm the correct positioning of the catheter tip</p> Signup and view all the answers

    Which preventive measure helps in maintaining catheter patency?

    <p>Routine flushing protocols</p> Signup and view all the answers

    What is a potential outcome of improper clamping of or using sharp instruments near a catheter?

    <p>Catheter tear, rupture, or pinhole damage</p> Signup and view all the answers

    In cases of alkaline precipitate with high pH, which treatment is generally recommended?

    <p>Sodium bicarbonate</p> Signup and view all the answers

    What is the minimum syringe size recommended for patency checks on catheters?

    <p>10 mL</p> Signup and view all the answers

    Which factor plays a significant role in causing catheter rupture during its maintenance?

    <p>Excessive pressure or tension on the catheter</p> Signup and view all the answers

    How should a ruptured or broken catheter be managed?

    <p>Utilize a manufacturer new hub kit for repair</p> Signup and view all the answers

    What approach should be taken when detecting sluggish flushing or absent blood return in a catheter?

    <p>Notify the healthcare provider for assessment</p> Signup and view all the answers

    What is NOT a recommended practice to prevent catheter occlusion?

    <p>Flushing against resistance</p> Signup and view all the answers

    What symptom may indicate damage to a catheter?

    <p>Tear, rupture, or pinhole on the external portion</p> Signup and view all the answers

    What should NOT be done when encountering resistance while flushing a catheter?

    <p>Forcefully push the flush syringe</p> Signup and view all the answers

    What is the consequence of lack of early detection and intervention in catheter maintenance?

    <p>Increased likelihood of catheter removal</p> Signup and view all the answers

    What should be done immediately after a catheter is identified as damaged?

    <p>Clamp catheter with padded hemostats or non-toothed hemostat.</p> Signup and view all the answers

    Which of the following accurately defines a CLABSI?

    <p>A laboratory-confirmed bloodstream infection associated with a catheter present for more than 2 days.</p> Signup and view all the answers

    What is the most prevalent catheter complication identified in clinical practice?

    <p>Catheter-related bloodstream infection (CRBSI).</p> Signup and view all the answers

    Which group of patients is considered to be immunocompromised due to advanced age?

    <p>Elderly individuals</p> Signup and view all the answers

    Which action is critical for preventing contamination during the catheter insertion process?

    <p>Ensuring proper hand hygiene and maximal sterile barrier precautions.</p> Signup and view all the answers

    What is the primary consideration when determining whether to replace a catheter hub or the entire catheter?

    <p>The risks and benefits of hub replacement versus catheter replacement.</p> Signup and view all the answers

    What is the minimum concentration of alcoholic chlorhexidine gluconate recommended for skin preparation during insertion and dressing changes?

    <blockquote> <p>0.5%</p> </blockquote> Signup and view all the answers

    Which technique is NOT advised for the disinfection of the needleless connector prior to access?

    <p>Soaking in saline solution</p> Signup and view all the answers

    What symptom might indicate the presence of a catheter-related infection?

    <p>Flush or infusate leakage from catheter.</p> Signup and view all the answers

    Which action should be performed routinely according to institutional policy for dressing changes?

    <p>Perform dressing changes as per guidelines</p> Signup and view all the answers

    Which factor is NOT associated with the cause of a catheter-related bloodstream infection (CRBSI)?

    <p>Excessive catheter manipulation.</p> Signup and view all the answers

    What type of assessment should follow the identification of a damaged catheter?

    <p>Assessment for reaction to catheter damage.</p> Signup and view all the answers

    What should be avoided to minimize the risk of CLABSI during CVAD insertion?

    <p>Insertion in a femoral vein</p> Signup and view all the answers

    Which type of dressing is recommended to be avoided for routine use?

    <p>Gauze dressings</p> Signup and view all the answers

    Which statement accurately represents the clinical definition of catheter-related bloodstream infection (CRBSI)?

    <p>CRBSI designates the catheter as the infection source without specifying the nature of the infection.</p> Signup and view all the answers

    What initial step should be taken if a situation involving a damaged catheter escalates to an emergent situation?

    <p>Prepare to transport the patient to an acute care setting.</p> Signup and view all the answers

    What is the purpose of using chlorhexidine/silver sulfadiazine impregnated CVADs?

    <p>To reduce CLABSI rates after unsuccessful strategies</p> Signup and view all the answers

    Which of the following is a commonly used antiseptic for skin preparation in patients allergic to chlorhexidine?

    <p>Iodine tincture</p> Signup and view all the answers

    What should be assessed daily to ensure infection prevention in CVAD management?

    <p>The need for each catheter</p> Signup and view all the answers

    Which of the following is NOT a recommended practice for preventing CRBSI?

    <p>Administering contaminated infusate</p> Signup and view all the answers

    What is a common symptom indicating the presence of pleural effusion?

    <p>Hypoxemia</p> Signup and view all the answers

    Which of the following treatments is considered a medical emergency for pericardial effusion tamponade?

    <p>Needle aspiration</p> Signup and view all the answers

    What symptom is indicative of Beck's Triad seen in pericardial effusion?

    <p>Muffled heart sounds</p> Signup and view all the answers

    What is one of the primary causes of pleural effusion in pediatric patients?

    <p>Mispositioning of a CVAD</p> Signup and view all the answers

    Which of the following findings can occur during a gradual evolution of pericardial effusion?

    <p>Marked fluctuations in heart rate</p> Signup and view all the answers

    What should be the immediate action taken upon diagnosis of pericardial effusion tamponade?

    <p>Notify the attending physician immediately</p> Signup and view all the answers

    What can be a significant indicator of pericardial effusion in infants, according to clinical observations?

    <p>Delayed capillary refill</p> Signup and view all the answers

    Which procedure is recommended for fluid removal in the case of pleural effusion?

    <p>Needle aspiration or chest tube insertion</p> Signup and view all the answers

    What structural characteristics are found in veins that are not present in arteries?

    <p>Valves to prevent backflow</p> Signup and view all the answers

    Which statement accurately describes the flow of blood in the systemic circulation?

    <p>Transports deoxygenated blood from the tissues to the right side of the heart</p> Signup and view all the answers

    Which type of blood flow is characterized by high pressure and rapid rates of flow?

    <p>Arterial blood flow</p> Signup and view all the answers

    What is the primary reason pulmonary arteries contain thicker walls compared to veins?

    <p>To support increased force of blood flow</p> Signup and view all the answers

    What is a key functional difference between veins and arteries in terms of their blood flow characteristics?

    <p>Veins have lower pressure, arteries have higher pressure.</p> Signup and view all the answers

    Which layer of a vein is responsible for maintaining its structural integrity?

    <p>Middle layer</p> Signup and view all the answers

    What is a unique feature of the pulmonary veins compared to other veins?

    <p>They carry oxygenated blood.</p> Signup and view all the answers

    What type of blood do pulmonary arteries transport and what is their primary function?

    <p>Deoxygenated blood for gas exchange in the capillaries</p> Signup and view all the answers

    Which characteristic is true for the tunica intima in veins?

    <p>Is composed of a single layer of smooth, flat endothelial cells</p> Signup and view all the answers

    Which physiological property is associated with arteries but not with veins?

    <p>Maintaining high blood pressure</p> Signup and view all the answers

    What is a unique feature of the cephalic vein in relation to catheter placement?

    <p>It often narrows as it ascends the upper extremity.</p> Signup and view all the answers

    Which statement best describes the basilic vein's characteristics and use for PICC placement?

    <p>It is classified as a superficial vein with a deep trajectory above the antecubital fossa.</p> Signup and view all the answers

    What is a primary reason the median vein is preferred for peripheral intravenous access?

    <p>It can be easily palpated and visualized in the antecubital fossa.</p> Signup and view all the answers

    How does the anatomy of the brachial vein affect its clinical application?

    <p>It is comprised of multiple veins that provide redundancy.</p> Signup and view all the answers

    What drawback is associated with placing a PICC line in the cephalic vein compared to the basilic vein?

    <p>The cephalic vein has a higher risk of thrombosis formation.</p> Signup and view all the answers

    What is a critical factor to consider when assessing the median vein for venipuncture?

    <p>The frequent variation in presentation and route.</p> Signup and view all the answers

    Which concerning aspect is associated with the cephalic vein when performing a PICC placement?

    <p>It often makes sharp turns as it approaches the axillary vein.</p> Signup and view all the answers

    In what way does the depth of the basilic vein impact clinical decisions?

    <p>Its deeper location contributes to a smooth route into the axillary vein.</p> Signup and view all the answers

    Which of the following best reflects the positioning of the median cubital vein?

    <p>It can be palpated and visualized at the antecubital fossa.</p> Signup and view all the answers

    What is the main anatomical route of the axillary vein?

    <p>Forms from the union of the basilic and brachial veins, continuing to the subclavian vein.</p> Signup and view all the answers

    Which statement regarding the external jugular vein is correct?

    <p>It can be easily accessed as it is a superficial vein, but routine CVAD insertion is not recommended.</p> Signup and view all the answers

    What is the recommended consideration for the use of the brachial vein in pediatric patients?

    <p>Understanding the child's ability to communicate symptoms of injury is crucial to avoid nerve complications.</p> Signup and view all the answers

    What condition makes the axillary vein a preferred site for CVAD insertion?

    <p>It provides a safer alternative to the subclavian vein.</p> Signup and view all the answers

    Which of the following statements about venous access sites is incorrect?

    <p>The axillary vein is classified as a superficial vein.</p> Signup and view all the answers

    Which complication is a known risk when using the external jugular vein for IV access?

    <p>Thrombosis and extravasation due to its tortuous course.</p> Signup and view all the answers

    What anatomical structure does the axillary vein terminate at?

    <p>At the lateral border of the first rib, continuing to the subclavian vein.</p> Signup and view all the answers

    What is a key clinical consideration when inserting a CVAD through the axillary vein?

    <p>Ultrasound guidance is essential to minimize complications.</p> Signup and view all the answers

    What is a significant anatomical characteristic of the basilic vein?

    <p>It combined with the brachial vein to form the axillary vein.</p> Signup and view all the answers

    Which clinical consideration is associated with the internal jugular vein?

    <p>It minimizes the risk of stenosis for AVF creation.</p> Signup and view all the answers

    What is a primary risk when inserting a catheter into the subclavian vein?

    <p>Increased risk of pneumothorax and hemothorax.</p> Signup and view all the answers

    How does ultrasound guidance improve CVAD placement?

    <p>It increases patient safety and success rate of insertion.</p> Signup and view all the answers

    Which anatomical feature of the axillary vein aids its function?

    <p>It allows for visible guidance during insertion procedures.</p> Signup and view all the answers

    In which situation should the subclavian vein NOT be used for catheter insertion?

    <p>In patients with chronic kidney disease Stage 3 or higher.</p> Signup and view all the answers

    What potentially adverse event can occur with a subclavian catheter insertion?

    <p>Catheter fracture due to direct arterial puncture.</p> Signup and view all the answers

    Why is the internal jugular vein preferred for VAD placement?

    <p>It has a relatively straight pathway to the brachiocephalic veins.</p> Signup and view all the answers

    What is a notable feature of the anatomical route of the subclavian vein?

    <p>It continues from the axillary vein.</p> Signup and view all the answers

    Which clinical consideration is associated with using the internal jugular vein for CVADs?

    <p>It is used to reduce infection risk compared to subclavian access.</p> Signup and view all the answers

    Why is the subclavian approach preferred over the internal jugular site for reducing CLABSI risk?

    <p>Infraclavicular sites have lower bioburden compared to neck sites.</p> Signup and view all the answers

    What anatomical structure contributes to the increased risk of venous thrombosis when catheter tips terminate in the brachiocephalic veins?

    <p>The sharp angle at which the left brachiocephalic vein enters the SVC.</p> Signup and view all the answers

    What is a significant drawback of utilizing the femoral vein for vascular access?

    <p>It is associated with a higher rate of CRBSI than other sites.</p> Signup and view all the answers

    Which is true regarding the common femoral vein's (CFV) application in vascular access device (VAD) placement?

    <p>It may be utilized in both acute and chronic settings.</p> Signup and view all the answers

    What anatomical landmarks define the superior border of the femoral triangle?

    <p>The inguinal ligament.</p> Signup and view all the answers

    Why may the femoral site be avoided for VAD placement, except in specific circumstances?

    <p>It poses risks for longer term catheter placements.</p> Signup and view all the answers

    What is the primary concern associated with devices placed via the common femoral vein?

    <p>There is insufficient data on their use for long-term access.</p> Signup and view all the answers

    Which statement accurately describes the anatomical path of the right brachiocephalic vein?

    <p>It passes vertically downward in front of the brachiocephalic artery.</p> Signup and view all the answers

    What is a common reason for using the femoral vein as a site for access?

    <p>It can be used when there are contraindications for neck or chest access.</p> Signup and view all the answers

    What is a key advantage of using femoral access in patients with profound respiratory failure?

    <p>It avoids the risk of hemothorax or pneumothorax.</p> Signup and view all the answers

    Which anatomical feature distinguishes the superior vena cava (SVC)?

    <p>Confluence of the left and right brachiocephalic veins.</p> Signup and view all the answers

    What is a disadvantage of accessing the femoral vein for catheter insertion?

    <p>The site is potentially contaminated due to perineal proximity.</p> Signup and view all the answers

    For optimal placement in patients receiving CVADs, where should catheter tips for IVC placement ideally reside?

    <p>Above the diaphragm in the inferior vena cava.</p> Signup and view all the answers

    In what scenario might the inferior vena cava (IVC) be used for vascular access?

    <p>SVC occlusion.</p> Signup and view all the answers

    What significant functional property does the SVC exhibit?

    <p>It facilitates rapid hemodilution of infusates.</p> Signup and view all the answers

    What must be carefully managed when placing catheters in the azygos vein?

    <p>Potential complications from occlusion of dominant collateral veins.</p> Signup and view all the answers

    What anatomical feature is observed in the inferior vena cava (IVC)?

    <p>It runs posteriorly to the abdominal cavity along the right side of the spinal column.</p> Signup and view all the answers

    Which catheter-related complication is least likely to occur when SVC tips are placed properly?

    <p>Venous thrombosis.</p> Signup and view all the answers

    What is an accurate statement regarding the access of the Azygos vein?

    <p>Catheter tips may require repositioning if malposition occurs.</p> Signup and view all the answers

    What is a primary clinical consideration when accessing the middle hepatic vein?

    <p>Transhepatic access may be necessary for certain vena cava conditions.</p> Signup and view all the answers

    Which anatomical feature is associated with the posterior vein?

    <p>It joins the posterior temporo-maxillary vein.</p> Signup and view all the answers

    What characterizes the lesser saphenous vein's accessibility?

    <p>It can be palpated or visualized above the ankle.</p> Signup and view all the answers

    What is an alternative access method for the inferior vena cava (IVC) mentioned?

    <p>Transhepatic access.</p> Signup and view all the answers

    Identify an incorrect statement regarding the lesser saphenous vein.

    <p>It can only be assessed through advanced imaging techniques.</p> Signup and view all the answers

    What is a key consideration when using transhepatic access?

    <p>The catheter tip must terminate in the IVC.</p> Signup and view all the answers

    What is a characteristic of the auricular vein?

    <p>The vein's anatomical description is less definitive in clinical contexts.</p> Signup and view all the answers

    Which statement regarding clinical considerations for veins is false?

    <p>The hepatic vein is not accessible in renal occlusion.</p> Signup and view all the answers

    What vein terminates in the external jugular?

    <p>Posterior temporo-maxillary vein.</p> Signup and view all the answers

    What is a significant anatomical feature of the saphenous vein?

    <p>It begins at the dorsal aspect of the foot.</p> Signup and view all the answers

    What anatomical feature may complicate catheter insertion into the saphenous vein?

    <p>Presence of numerous valves</p> Signup and view all the answers

    Which vein is associated with a clinical consideration of avoiding insertion during crawling or ambulatory conditions?

    <p>Saphenous vein</p> Signup and view all the answers

    What is the maximum time frame for catheter placement in the umbilical vein post-birth?

    <p>1 week</p> Signup and view all the answers

    Which artery is most commonly used for arterial line placement due to its superficial nature?

    <p>Radial artery</p> Signup and view all the answers

    What must be performed prior to accessing the radial artery to ensure collateral blood flow?

    <p>Allen’s Test</p> Signup and view all the answers

    What additional technique may be required for the cannulation of the brachial artery?

    <p>Ultrasound guidance</p> Signup and view all the answers

    What is a key anatomical consideration to visualize the popliteal vein?

    <p>Visibility in the popliteal space by palpation</p> Signup and view all the answers

    In critically ill infants, which type of catheter placement is permissible in the umbilical vein?

    <p>Both single or dual lumen catheters</p> Signup and view all the answers

    What condition must be considered when performing a catheter access in the lower extremities?

    <p>Patient's ambulation status</p> Signup and view all the answers

    What anatomical pathway does the radial artery follow?

    <p>Along the radial side of the forearm to the wrist</p> Signup and view all the answers

    What is the main reason the brachial artery is not recommended for pediatric patients?

    <p>It has limited collateral blood flow.</p> Signup and view all the answers

    Where is the femoral artery best palpated?

    <p>Below the inguinal ligament, midway between the anterior superior spine and the pubic symphysis.</p> Signup and view all the answers

    In a patient with chronic kidney disease, what is the recommended practice prior to vascular access device insertion?

    <p>Consultation with a vascular access specialist and nephrologist.</p> Signup and view all the answers

    What is a significant risk when performing vascular access on a patient post-mastectomy with axillary lymph node dissection?

    <p>Development of lymphedema in the contralateral arm.</p> Signup and view all the answers

    Which comorbidity should be a consideration when selecting a vascular access device?

    <p>Diabetes mellitus and lymphedema.</p> Signup and view all the answers

    Why is it important to avoid vascular access device insertion in the arm with a potential future AV fistula?

    <p>It can result in stenosis which affects hemodialysis access.</p> Signup and view all the answers

    What is the rationale for consulting a nephrologist prior to vascular access procedures in patients with stage 3 chronic kidney disease?

    <p>For a comprehensive documented plan of care.</p> Signup and view all the answers

    In patients with chronic kidney disease, why should the insertion of vascular access devices be avoided in the arm where an AV fistula is being created?

    <p>Potential serious complications from vessel damage.</p> Signup and view all the answers

    For patients with lymphedema risk, which site is advised for vascular access device insertion?

    <p>Contralateral arm only.</p> Signup and view all the answers

    What is a critical consideration in evaluating a patient's history prior to vascular access device placement?

    <p>The type and site of previous devices used.</p> Signup and view all the answers

    What is a significant risk when placing a VAD in a vessel with known stenosis?

    <p>Increased risk for thrombosis and infection</p> Signup and view all the answers

    What should be avoided to prevent complications in patients with a history of central venous access device occlusion?

    <p>Inserting devices in the lower extremities</p> Signup and view all the answers

    Why is it recommended to use the smallest gauge catheter necessary for therapeutic goals?

    <p>To minimize damage to the vein wall</p> Signup and view all the answers

    Which factor is essential to evaluate before placing a CVAD in a patient with known thrombosis?

    <p>The location and degree of stenosis</p> Signup and view all the answers

    What is a critical consideration when inserting a VAD in pediatric patients?

    <p>Avoidance of lower extremity insertion</p> Signup and view all the answers

    What can lead to cumulative damage in superficial veins during catheter use?

    <p>Repeated or ongoing exposure to caustic infusates</p> Signup and view all the answers

    How does endothelial layer damage initiate a response during catheter insertion?

    <p>It activates blood factors to deposit fibrin</p> Signup and view all the answers

    What does placing a device safely in the SVC or IVC require?

    <p>An understanding of the venous anatomy and stenosis</p> Signup and view all the answers

    When should implanted long-term CVAD insertion be avoided?

    <p>During acute bacteremia or sepsis</p> Signup and view all the answers

    What composes the primary source of structural damage to veins during VAD insertion?

    <p>Vein wall puncture from device insertion</p> Signup and view all the answers

    Which action should be taken regarding vascular access device (VAD) insertion in the presence of significant skin trauma?

    <p>Use the least invasive VAD available that achieves the therapeutic goal.</p> Signup and view all the answers

    What is the recommended strategy for inserting a central venous access device (CVAD) in patients with congenital heart disease?

    <p>Place the SVC or IVC tip for safety and longer dwell time.</p> Signup and view all the answers

    When considering vascular access in patients with morbid obesity, which factor is crucial?

    <p>Reliable maintenance of a dry dressing at insertion sites.</p> Signup and view all the answers

    In patients with permanent pacemakers or AICDs, what is a key consideration for central line placement?

    <p>Consult cardiologists for any ipsilateral placements.</p> Signup and view all the answers

    What should be the main focus when addressing vascular conditions like Reynaud's syndrome during vascular access?

    <p>Choosing the smallest gauge necessary for the therapeutic goal.</p> Signup and view all the answers

    What should be avoided when inserting a CVAD in the presence of an automatic implanted cardioverter defibrillator (AICD)?

    <p>Inserting on the ipsilateral side without care.</p> Signup and view all the answers

    When managing patients with significant vascular issues, what is the primary goal for catheter selection?

    <p>Minimizing the risk of complications with the smallest pertinent gauge.</p> Signup and view all the answers

    What is a prudent approach when determining the site for VAD insertion in a patient with a recent fracture?

    <p>Avoid the side of the fracture altogether.</p> Signup and view all the answers

    In the context of congenital heart disease, what can impact the successful placement of a PICC?

    <p>Considering the insertion site in relation to existing anatomy and occlusion risks.</p> Signup and view all the answers

    Which methodology is most effective for avoiding complications during VAD insertion in obese patients?

    <p>Employing ultrasound guidance and experienced clinicians.</p> Signup and view all the answers

    What is the primary cause of structural damage leading to stenosis in patients requiring frequent vascular access?

    <p>Permanent scarring in major vessels</p> Signup and view all the answers

    Which condition is characterized by damage to the endothelial layer of veins?

    <p>Vein wall puncture</p> Signup and view all the answers

    What critical factor is considered when assessing peripheral veins in patients with chronic kidney disease?

    <p>Number of past venipunctures</p> Signup and view all the answers

    Which IV catheter location is generally preferred for short-term infusions in patients with CKD stage-3 or greater?

    <p>Dorsal metacarpal veins of the dominant hand</p> Signup and view all the answers

    What is the consequence of repeatedly using veins in the upper arm for venous access procedures?

    <p>Permanent damage for future hemodialysis access</p> Signup and view all the answers

    What role does fibrin play in the process following a vein wall injury?

    <p>It forms a stable blood clot over the platelet plug</p> Signup and view all the answers

    What is a key reason for avoiding the use of certain upper extremity veins for venous access in CKD patients?

    <p>They are critical for hemodialysis access in the future</p> Signup and view all the answers

    Which of the following factors contributes to the risk of arteriovenous fistula in hemodialysis patients?

    <p>pH extremes in infusates</p> Signup and view all the answers

    What should be assessed to determine if veins are suitable for future hemodialysis access?

    <p>Presence of permanent vascular injuries</p> Signup and view all the answers

    What is a common consequence of exposure to caustic infusates in patients undergoing hemodialysis?

    <p>Increased risk of stenosis or thrombosis</p> Signup and view all the answers

    What major fear is typically associated with infants aged 0-18 months?

    <p>Separation anxiety</p> Signup and view all the answers

    Which emotional support strategy is recommended for children aged 18 months to 3 years during medical procedures?

    <p>Limit provider presence to the minimum needed</p> Signup and view all the answers

    During the preschool stage (2-5 years), which fear is most prevalent among children?

    <p>Fear of the unknown</p> Signup and view all the answers

    What is a recommended emotional support method for infants up to 18 months during medical procedures?

    <p>Encouraging the presence of familiar caregivers</p> Signup and view all the answers

    For a child aged 3 years undergoing a procedure, which technique is NOT typically recommended?

    <p>Avoiding any distractions or comfort items</p> Signup and view all the answers

    What type of support is key for toddlers aged 1-3 years during medical procedures?

    <p>Allowing parents to be present if beneficial</p> Signup and view all the answers

    Which of the following behaviors is common in infants related to emotional support?

    <p>Communicating primarily through crying</p> Signup and view all the answers

    What is considered a major fear for preschool-aged children during medical procedures?

    <p>Fear of bodily injury</p> Signup and view all the answers

    What is an appropriate distraction technique for toddlers undergoing medical procedures?

    <p>Offering music and lighted spinners</p> Signup and view all the answers

    In preschool children, which approach is beneficial to reduce anxiety during a procedure?

    <p>Allowing decisions between two options</p> Signup and view all the answers

    What is a primary concern for children aged 3 to 5 years when undergoing medical procedures?

    <p>Fear of bodily injury and mutilation</p> Signup and view all the answers

    Which approach should be prioritized for children aged 6 to 12 years during treatment?

    <p>Encourage presence of parents when beneficial</p> Signup and view all the answers

    What phase of development is a child aged 13 to 18 years primarily concerned with?

    <p>Identity vs. role confusion</p> Signup and view all the answers

    What is an effective distraction technique for school-age children during a procedure?

    <p>Listening to music or a guided imagery session</p> Signup and view all the answers

    Which of the following strategies is crucial in providing care to adolescents?

    <p>Involve them in discussions about their care</p> Signup and view all the answers

    What is an appropriate method for caregivers to limit fear of bodily injury in young children during procedures?

    <p>Use simple instructions with non-threatening vocabulary</p> Signup and view all the answers

    What is a recommended positioning technique for comforting a child during medical procedures?

    <p>Allow the child to choose their comfort position</p> Signup and view all the answers

    What approach helps foster cooperation in children during treatment?

    <p>Praise often for cooperation and compliance</p> Signup and view all the answers

    How should healthcare professionals handle the environment for children undergoing treatment?

    <p>Create a calm and supportive environment away from typical stressors</p> Signup and view all the answers

    Which comfort measure is unlikely to be effective for adolescents during procedures?

    <p>Using bubbles as a distraction</p> Signup and view all the answers

    What is the primary chronic disease affecting arterial circulation in the aging population?

    <p>Diabetes mellitus</p> Signup and view all the answers

    Which factor is least likely to impact an individual's circulatory system?

    <p>Regular exercise</p> Signup and view all the answers

    What is the normal range for white blood cells (WBC) in adults?

    <p>4.5-10 thousand per microliter (mcL)</p> Signup and view all the answers

    Which of the following is a direct indicator of kidney function?

    <p>Glomerular Filtration Rate (GFR)</p> Signup and view all the answers

    Which condition is NOT typically associated with age-related vascular changes?

    <p>Asthma</p> Signup and view all the answers

    What is a change in the skin associated with aging?

    <p>Dehydration</p> Signup and view all the answers

    What might elevated white blood cells indicate in an aging adult?

    <p>Active infection</p> Signup and view all the answers

    Which of the following mechanisms is NOT used to estimate Glomerular Filtration Rate (GFR)?

    <p>Urinary output measurement</p> Signup and view all the answers

    What lifestyle factor is NOT typically associated with vascular health decline?

    <p>Healthy balanced diet</p> Signup and view all the answers

    Which laboratory value is most critical to assess before placing a vascular access device?

    <p>White blood cell count</p> Signup and view all the answers

    What does a GFR less than 60 mL/min/1.73 m2 for more than 3 months indicate?

    <p>Chronic Kidney Disease</p> Signup and view all the answers

    What should be correlated with an elevated serum creatinine level of 2 mg/dL or greater?

    <p>GFR or eGFR values</p> Signup and view all the answers

    What is the normal range for platelet count in adults?

    <p>150-450 thousand per mcl</p> Signup and view all the answers

    What does a processed International Normalized Ratio (INR) of 2.1-3.0 indicate?

    <p>Therapeutic range for anticoagulant therapy</p> Signup and view all the answers

    In which scenario is a PICC considered the most appropriate vascular access device?

    <p>In hypercoagulable patients</p> Signup and view all the answers

    What must be prioritized before venipuncture in a patient with potential CKD?

    <p>Comprehensive vascular access plan</p> Signup and view all the answers

    When might platelet transfusions be administered prior to vascular access device (VAD) insertion?

    <p>Based on the discretion of the provider and patient needs</p> Signup and view all the answers

    Why is monitoring INR critical for patients on Vitamin K antagonists?

    <p>To adjust anticoagulant doses appropriately</p> Signup and view all the answers

    What factor does NOT determine contraindications for PICC placement?

    <p>Patient comfort level</p> Signup and view all the answers

    What is a crucial step to identify patients who might need dialysis access like a hemodialysis fistula?

    <p>Serum creatinine assessments</p> Signup and view all the answers

    How does increasing frequency of ultrasound (US) waves affect penetration through soft tissues?

    <p>Decreases penetration while increasing resolution</p> Signup and view all the answers

    Which material poorly reflects ultrasound waves and appears black on imaging?

    <p>Blood</p> Signup and view all the answers

    What is the impact of gain settings on ultrasound imaging?

    <p>High gain can lead to overly bright images</p> Signup and view all the answers

    How does the resolution of ultrasound images relate to frequency?

    <p>Higher frequency increases resolution with decreased penetration</p> Signup and view all the answers

    What dimension does the transverse plane visualize in ultrasound imaging?

    <p>Cross-sectional dimension of an object</p> Signup and view all the answers

    In what manner does ultrasound interact with solid materials?

    <p>Sound waves are nearly completely reflected back</p> Signup and view all the answers

    What happens to ultrasound image quality when the frequency is lowered?

    <p>Decreased resolution but greater penetration</p> Signup and view all the answers

    What role does the transducer probe play in ultrasound imaging?

    <p>Receives reflected waves and creates images</p> Signup and view all the answers

    Which factor is essential for good image quality in ultrasound when considering attenuation?

    <p>Higher frequency leads to less attenuation</p> Signup and view all the answers

    What image characteristic does the longitudinal plane primarily emphasize?

    <p>Lengthwise dimensions of objects</p> Signup and view all the answers

    In a longitudinal view, how do veins appear during an ultrasound examination?

    <p>As long tubes with a dark exterior</p> Signup and view all the answers

    What is the role of ultrasound gel in ultrasound procedures?

    <p>To transmit ultrasound energy by eliminating air interfaces</p> Signup and view all the answers

    Which statement best describes the appearance of arteries during an ultrasound exam when lightly compressed?

    <p>They appear as tubes and pulsate with compression</p> Signup and view all the answers

    What function do needle guides serve when performing ultrasound-guided procedures?

    <p>They align the needle at the correct angle to enter the vessel</p> Signup and view all the answers

    How is the depth of the image controlled during an ultrasound scan?

    <p>By manually adjusting the depth setting based on user preference</p> Signup and view all the answers

    When using ultrasound to identify vessels, what characteristic helps differentiate veins from arteries?

    <p>Veins appear as tubes with no pulsation; arteries pulsate</p> Signup and view all the answers

    What is the primary purpose of placing a sterile probe cover on the transducer?

    <p>To maintain a sterile field during the procedure</p> Signup and view all the answers

    What visual feature is characteristic of veins when viewed in transverse orientation?

    <p>They appear as round objects with a blackish center</p> Signup and view all the answers

    What defines Stage 2 of Chronic Kidney Disease (CKD)?

    <p>Kidney damage with mildly decreased GFR</p> Signup and view all the answers

    What is the normal range for Prothrombin Time (PT) in seconds?

    <p>11-13.5 seconds</p> Signup and view all the answers

    What indication does real-time imaging provide during an ultrasound procedure?

    <p>Rapidly changing images for dynamic assessment</p> Signup and view all the answers

    What happens to veins when the transducer probe compresses the surrounding soft tissue?

    <p>They collapse easily and do not pulsate</p> Signup and view all the answers

    What is the GFR level associated with kidney failure?

    <p>Less than 15</p> Signup and view all the answers

    What is the primary purpose of ultrasound guidance during CVAD insertion?

    <p>To improve safety and efficiency of catheter placement</p> Signup and view all the answers

    Which component is associated with the intrinsic pathway of coagulation?

    <p>Activated Partial Thromboplastin Time (aPTT)</p> Signup and view all the answers

    What is the significance of the catheter to vessel ratio in ultrasound assessments?

    <p>It assesses vessel health and compressibility.</p> Signup and view all the answers

    How is attenuation defined in ultrasound physics?

    <p>The loss of sound energy as it travels through a medium.</p> Signup and view all the answers

    Which frequency range is typically used in medical ultrasound?

    <p>2 MHz to 15 MHz</p> Signup and view all the answers

    What is the normal range for partial thromboplastin time (PTT) in seconds?

    <p>25-35 seconds</p> Signup and view all the answers

    What role does electromagnetic tip navigation serve during catheter insertion?

    <p>It aids in visualizing the vascular pathway for accurate placement.</p> Signup and view all the answers

    Which feature enhances the visualization of a needle during ultrasound guidance?

    <p>Implementing a needle with echogenic features.</p> Signup and view all the answers

    Why might it be challenging to visualize nerves during vascular access?

    <p>Nerves have similar acoustic impedance to surrounding soft tissues.</p> Signup and view all the answers

    What advantage does fluoroscopy provide during central venous access device (CVAD) insertion?

    <p>It can show real-time vascular pathway variations.</p> Signup and view all the answers

    What function does the saline column in the intravascular ECG method serve?

    <p>It replaces traditional electrodes for electrical signal detection.</p> Signup and view all the answers

    What is a potential limitation of using electromagnetic tip navigation independently?

    <p>It may not detect all catheter malpositions accurately.</p> Signup and view all the answers

    What does a bright white reflection seen during ultrasound indicate?

    <p>The needle shaft reflecting the ultrasound beam.</p> Signup and view all the answers

    Which of the following conditions can be identified using fluoroscopy during CVAD insertion?

    <p>Presence of stenosis or occlusion.</p> Signup and view all the answers

    What should practitioners do if electromagnetic tip navigation is used without ECG or Doppler validation?

    <p>Ensure a post-placement chest X-Ray is conducted.</p> Signup and view all the answers

    In which position should the needle be directed for optimal visualization during cannulation?

    <p>In the middle of the intended vein to be cannulated.</p> Signup and view all the answers

    What does the maximal P wave prior to deflection indicate during catheter tip placement?

    <p>The catheter tip is in the proximal right atrium.</p> Signup and view all the answers

    Why is a Posterior-Anterior (PA) position preferred for chest X-ray when confirming catheter tip location?

    <p>It draws on greater radiation energy.</p> Signup and view all the answers

    What common factor can interfere with the interpretation of catheter tip location in patients?

    <p>Presence of spinal rods.</p> Signup and view all the answers

    What is the role of a stylet with a Doppler built into the tip during catheter placement?

    <p>To determine the direction of blood flow.</p> Signup and view all the answers

    What critical aspect should be ensured when ordering chest X-rays for CVAD tip location?

    <p>Optimization of settings for visualization.</p> Signup and view all the answers

    What area features prominently in the Cincinnati Triangle with regards to catheter tip placement?

    <p>3-5 cm below the carina.</p> Signup and view all the answers

    Which situation may challenge the ability to determine catheter tip location accurately?

    <p>Presence of a pacemaker.</p> Signup and view all the answers

    Which condition is essential for optimizing the visual accuracy during CVAD tip identification via X-ray?

    <p>Maintaining a standing position.</p> Signup and view all the answers

    What is one of the factors that could lead to discrepancies in catheter tip placement interpretation among providers?

    <p>Variability in individual provider experiences.</p> Signup and view all the answers

    What type of X-ray position can result in greater distortion of the catheter's appearance?

    <p>Anterior-Posterior (AP) position.</p> Signup and view all the answers

    What is the primary purpose of a Professional Licensure Examination in a professional field?

    <p>To assess minimal competency</p> Signup and view all the answers

    Which of the following best describes certification in a professional context?

    <p>Recognition by a professional organization of achieved standards</p> Signup and view all the answers

    Which phase of interdisciplinary collaboration involves participants negotiating their rights to participate?

    <p>Problem Setting</p> Signup and view all the answers

    What constitutes professional development in the context of healthcare?

    <p>Assessing and enhancing competencies</p> Signup and view all the answers

    Which statement correctly describes clinical practice guidelines?

    <p>Systematically developed statements based on research</p> Signup and view all the answers

    What is a major challenge in the education of vascular access and infusion therapy?

    <p>Lack of hands-on skills validation</p> Signup and view all the answers

    What characterizes a mentor in a healthcare setting?

    <p>An experienced colleague providing guidance</p> Signup and view all the answers

    What is one function of standards of practice within a profession?

    <p>To describe professional responsibilities</p> Signup and view all the answers

    What technology is NOT typically used for vascular access teaching?

    <p>Traditional lecture-based instruction</p> Signup and view all the answers

    Which option describes the outcome of effective interdisciplinary collaboration?

    <p>A synthesis of various perspectives</p> Signup and view all the answers

    Which mentoring approach involves one mentor guiding a small group of mentees?

    <p>Group mentoring</p> Signup and view all the answers

    What is an essential aspect of fostering a successful mentoring relationship?

    <p>Fostering relationships both formally and informally</p> Signup and view all the answers

    In patient education, which of the following is crucial for verifying a learner's comprehension?

    <p>Engaging in teach-back methods</p> Signup and view all the answers

    Which of these is NOT a recognized source for educational materials regarding vascular access devices?

    <p>Social media influencers</p> Signup and view all the answers

    What factor significantly affects the decision-making ability of cognitively impaired individuals according to the outlined considerations?

    <p>Understanding of the information involved</p> Signup and view all the answers

    Which organization is focused specifically on patient safety related to enteral and parenteral nutrition?

    <p>Oley Foundation</p> Signup and view all the answers

    What is a primary responsibility of a mentor in the mentoring process?

    <p>To facilitate professional growth and development</p> Signup and view all the answers

    Which of the following is a recommended practice when educating patients about potential complications during therapy?

    <p>Encouraging discussions about potential problems during therapy</p> Signup and view all the answers

    Which of the following approaches involves several mentors collaborating with a small group of mentees?

    <p>Team mentoring</p> Signup and view all the answers

    What is a common resource for patient education materials that can be used for demonstration and practice?

    <p>Device manufacturers</p> Signup and view all the answers

    What should be included in the formalized document that travels with a patient during care site transitions?

    <p>Detailed information regarding the indwelling VAD</p> Signup and view all the answers

    Which level of clinical competency demonstrates an intuitive grasp of problems and effortless skill performance?

    <p>Expert</p> Signup and view all the answers

    Which component should NOT be included in patient and caregiver education regarding VAD details?

    <p>Patient's medical history prior to the VAD placement</p> Signup and view all the answers

    What factor can significantly influence the selection of the VAD, care setting, and therapy?

    <p>Costs of therapy and provisions of insurance coverage</p> Signup and view all the answers

    How is clinical competency defined in the context of medicine?

    <p>Knowledge, skills, attitudes, and ability to integrate understanding</p> Signup and view all the answers

    Which statement about the components of the transition document is accurate?

    <p>It must include information about recent therapy and expected outcomes.</p> Signup and view all the answers

    Which of the following describes the 'Advanced Beginner' level of clinical competency?

    <p>Able to demonstrate marginally acceptable performance</p> Signup and view all the answers

    What is typically included as part of a competency assessment?

    <p>Evaluation of technical skills, critical thinking, and application of knowledge</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the 'Competent' stage in clinical competency?

    <p>Ability to instinctively resolve complex situations</p> Signup and view all the answers

    What should caregivers be educated on regarding variations in care across different settings?

    <p>Differences may arise due to the setting and resources available</p> Signup and view all the answers

    Why should patients' family members not be used to interpret medical conversations?

    <p>Their emotional involvement may bias translations.</p> Signup and view all the answers

    What is a crucial consideration when preparing informed consent forms for patients?

    <p>Translating them into the patient's preferred language.</p> Signup and view all the answers

    How should clinicians approach patients with multiple vulnerabilities, such as those with mental illness and imprisonment?

    <p>Handle the situation with heightened awareness and sensitivity.</p> Signup and view all the answers

    Which type of health belief views disease as a disruption of natural balance within the body?

    <p>Holistic.</p> Signup and view all the answers

    What key factor distinguishes magic-spiritual health beliefs from other types?

    <p>Belief in supernatural forces causing illness.</p> Signup and view all the answers

    Why is it important for clinicians to be sensitive to the cultural beliefs of patients?

    <p>To avoid conflicts and build trust in the patient-clinician relationship.</p> Signup and view all the answers

    What is a significant risk associated with coerced medical decisions involving vulnerable populations?

    <p>Power dynamics leading to exploitation or harm.</p> Signup and view all the answers

    In situations where professional interpreters are unavailable, what should clinicians do?

    <p>Consult the facility's policy regarding interpretation assistance.</p> Signup and view all the answers

    Which demographic is considered part of vulnerable populations that need special consideration in medical settings?

    <p>The aging population.</p> Signup and view all the answers

    What is a common outcome if clinicians fail to respect a patient's religious beliefs during medical care?

    <p>Reduced treatment adherence.</p> Signup and view all the answers

    What is the key outcome when patients are actively engaged in their own health care?

    <p>Reduction in medical errors</p> Signup and view all the answers

    Which strategy is effective in promoting patient engagement during acute care stays?

    <p>Communication about care planning and discharge throughout the stay</p> Signup and view all the answers

    How should informed consent for CVAD placement be approached?

    <p>It should be a collaborative educational process involving shared decision-making</p> Signup and view all the answers

    What percentage of patients felt that their education regarding risks of CVAD placement could be improved?

    <p>40%</p> Signup and view all the answers

    What is a common misconception regarding patient involvement in CVAD site selection?

    <p>Patient opinions are often disregarded during the selection process</p> Signup and view all the answers

    What educational level should materials for informed consent ideally be tailored to?

    <p>Between 4th and 6th grades</p> Signup and view all the answers

    What is considered a significant barrier to effective patient engagement?

    <p>Providing excessive information at once</p> Signup and view all the answers

    Which factor significantly influences the likelihood of patient engagement in their care?

    <p>Relating goals of engagement to specific information needs</p> Signup and view all the answers

    What role does the entire healthcare team play in patient education?

    <p>The entire team must be involved in patient education for effectiveness</p> Signup and view all the answers

    What is the best approach for patients seeking opinions about their care?

    <p>Utilize online health information to express informed preferences</p> Signup and view all the answers

    What is a critical factor in determining the level of patient education for CVAD care?

    <p>The patient's clinical condition and their ability to participate</p> Signup and view all the answers

    Why is it important for patients and caregivers to know how to check for complications associated with their CVAD?

    <p>To effectively challenge healthcare providers on practices</p> Signup and view all the answers

    When providing education to patients with CVADs, what is a recommended approach?

    <p>Utilize verbal communication and allow adequate time for questions</p> Signup and view all the answers

    What type of education might be limited for acute care patients requiring a short-term CVAD?

    <p>Education based on the patient's clinical condition</p> Signup and view all the answers

    Which aspect of CVAD education is particularly important for caregivers involved in home care?

    <p>Basic knowledge about the catheter and complication management</p> Signup and view all the answers

    What should patients be taught regarding their CVAD during education sessions?

    <p>General care practices, including catheter flushing and dressing changes</p> Signup and view all the answers

    What is one of the primary responsibilities of home care clinician nurses related to CVAD site care?

    <p>Conducting routine site care in outpatient settings</p> Signup and view all the answers

    For patients with implanted ports, what is usually the degree of care required?

    <p>Minimal care unless the port is accessed for infusion</p> Signup and view all the answers

    What role does patient education play in preventing suboptimal infection prevention processes?

    <p>It builds confidence to challenge healthcare providers</p> Signup and view all the answers

    What should caregivers focus on to ensure effective CVAD management at home?

    <p>Knowledge of complications and proper protection during daily activities</p> Signup and view all the answers

    Which factor is most crucial for clinicians to deliver effective multicultural care?

    <p>Cultural and spiritual awareness and competence</p> Signup and view all the answers

    What significant change may occur in a patient's belief system regarding health treatments over time?

    <p>Patients may adopt spiritual practices when conventional treatments fail</p> Signup and view all the answers

    What intervention is least effective in improving cultural competence among healthcare providers?

    <p>Providing standard healthcare materials regardless of cultural context</p> Signup and view all the answers

    How might patients' perceptions of health and illness influence healthcare utilization?

    <p>They may refuse certain treatments based on cultural beliefs</p> Signup and view all the answers

    What is the potential impact of a patient's cultural beliefs on their healthcare decisions?

    <p>They can result in a rejection of both traditional and non-traditional treatments</p> Signup and view all the answers

    What type of healthcare program is specifically designed for American Indians and Alaska Natives?

    <p>Indian Health Service</p> Signup and view all the answers

    What is one method to enhance communication with clients who have limited English proficiency?

    <p>Hiring interpreters or bilingual staff</p> Signup and view all the answers

    Which characteristic is most relevant to understanding health beliefs on a continuum?

    <p>Beliefs might transform as patients' experiences evolve</p> Signup and view all the answers

    What is the recommended approach for assessing a patient's beliefs in healthcare?

    <p>Conduct individual assessments to understand their beliefs</p> Signup and view all the answers

    Study Notes

    Catheter Occlusion

    • Dysfunction of an indwelling catheter caused by mechanical, thrombotic, or non-thrombotic occlusion.
    • Determining the cause of the occlusion is key to resolving the issue.

    Prevention of Catheter Occlusion

    • Use ultrasound (US) guidance for all central venous access device (CVAD) insertions.
    • Ensure proper vessel and catheter selection.
    • Minimize fibrin accumulation through routine flushing protocols.
    • Avoid restrictive clothing and devices.
    • Limit heavy lifting and excessive exercise.
    • Utilize stabilization devices and proper dressings.
    • Do not flush against resistance.
    • Use a larger syringe for patency checks.
    • Avoid sharp instruments near the catheter during dressing changes.
    • Use adhesive remover when changing transparent dressings.
    • Application of chlorhexidine-impregnated disc or dressing.
    • Avoid routine use of gauze dressings.
    • Disinfect the needleless connector, injection port or catheter hub using 70% Isopropyl alcohol or alcoholic chlorhexidine gluconate solution before each access.
    • Ensure proper tip placement, appropriate stabilization, and secure dressing.
    • Proactive maintenance, early detection, and correction of dysfunction.
    • Ensure proper tip location and routine flushing protocols, use flush agents appropriate for medications, ensure proper administration protocols, use a Push-Pause technique.
    • Use 10 mL or larger syringe (or equivalent barrel size) for all patency checks.
    • Avoid use of sharp instruments near catheter such as scissors when performing dressing change.
    • Avoid using gauze dressings.
    • Disinfect the needleless connector prior to each access.
    • Use of passive disinfection caps.
    • Application of chlorhexidine-impregnated disc or dressing.
    • Perform dressing changes according to institutional policy.
    • Avoid using sharp instruments near catheter during dressing changes.
    • Use appropriate antiseptic solution to maintain sterility.
    • Maintain appropriate sterility of the infusion site.
    • Use appropriate personal protective equipment (PPE) during procedures.
    • Use aseptic technique during all procedures.
    • Use chlorhexidine-impregnated dressings to maintain sterility.
    • Strict adherence to evidence-based CRBSI prevention guidelines.

    Symptoms of Catheter Occlusion

    • May be asymptomatic.
    • Inability or difficulty infusing.
    • Leaking at the insertion site.
    • Erythema.
    • Pallor.
    • Pain.
    • Edema.
    • Collateral veins may appear.
    • Numbness in the affected extremity, shoulder, neck, or chest.
    • Fibrin can coat the catheter surface.
    • Partial or total occlusion of the vessels is possible.
    • Thrombus may embolize.
    • Pulmonary embolism or other embolic complications.
    • Post Thrombotic Syndrome.
    • Difficulty or inability to infuse.
    • Sluggish or absent blood return.
    • Leakage from catheter.
    • Catheter embolus, infection, infiltration, extravasation, and air embolism.
    • Signs of sepsis (e.g., hypotension, tachycardia, fever, chills, pain, malaise, elevated white blood cell count, or confusion).
    • Signs of infection (purulent drainage, erythema).

    Mechanical Occlusion

    • Causes: Catheter movement/inadequate device securement, mechanical obstruction, kink in catheter or tubing, tip malposition (pinch-off syndrome), improper clamping or excessive manipulation. Improper use, inadequate maintenance, lack of early detection.
    • Prevention: Ensure proper tip placement, routine flushing, appropriate stabilization, secure dressing, use correct flush agents, and ensure proper administration protocols. Ensure proper tip location and routine flushing protocols, use flush agents appropriate for medications/infusions, ensure proper administration protocols, use a Push-Pause technique. Follow manufacturer's instructions for catheter maintenance.
    • Symptoms: Difficulty or inability to infuse, sluggish or absent blood return, symptoms of sepsis (eg, hypotension, tachycardia, fever, chills, pain, malaise, elevated white blood cell count, or confusion), signs of infection (purulent drainage, erythema).
    • Treatment: Determine type of occlusion/dysfunction, catheter removal if necessary. Remove add-on extension sets; change the needleless connector; inspect external catheter length for kinks; chest radiography if indicated; and use appropriate flush protocols for the solution administered to resolve the obstruction.

    Thrombotic Occlusion

    • Causes: High catheter to vein ratio (CVR), catheter movement/inadequate securement, fibrin tail (accumulation of fibrin), intraluminal thrombus, improper use/inadequate maintenance, lack of early detection.
    • Prevention: Proactive maintenance, early detection, and correction of dysfunction, ensure proper tip location and routine flushing, appropriate stabilization, & secure dressing, use correct flush agents, and ensure proper administration protocols; adhere to manufacturer recommendations.
    • Symptoms: Difficulty or inability to infuse, sluggish or absent blood return, symptoms of sepsis (eg, hypotension, tachycardia, fever, chills, pain, malaise, elevated white blood cell count, or confusion), signs of infection (purulent drainage, erythema).
    • Treatment: Rule out tip malposition and mechanical factors, administering of clearing agent (Alteplase or other FDA cleared thrombolytic) following institutional policy, consider antimicrobial lock solutions and catheter removal if necessary. Repeat prevention steps.

    Non-Thrombotic Occlusion

    • Causes: Incompatible medications/solutions, lipid accumulation, mineral/acidic precipitates (low pH), precipitation caused by incompatible medications/ solutions, lipid accumulation in the catheter lumen, mineral/acidic precipitates, use of non-compatible medications/infusions, not maintaining appropriate sterility of the infusion site.
    • Prevention: Proactive maintenance, routine flushing, use flush agents, appropriate for medications/infusions, ensure proper administration protocols, use a Push-Pause technique, avoid using gauze dressings, maintain appropriate sterility, use of chlorhexidine-impregnated dressings, & strict adherence to evidence-based CRBSI prevention guidelines.
    • Symptoms: Difficulty or inability to infuse, sluggish or absent blood return, symptoms of sepsis, signs of infection.
    • Treatment: Evaluate recent infusates, consult a pharmacist, treat mineral/acidic precipitate with low pH with HCI per physician or institutional protocol, consider antimicrobial lock solutions, catheter removal if necessary; flush with saline, follow with heparin if ordered; assess infection/inflammation.
    • Additional Treatment Considerations: Utilize antiseptic solutions to maintain sterility, use chlorhexidine-impregnated dressings, consider antimicrobial lock solutions. Use appropriate flushing protocols for specific medications/infusions, and ensure use of appropriate flush solutions. Perform dressing changes and prevent exposure to contamination. Ensure aseptic technique during all procedures, use appropriate PPE.

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    Description

    This quiz covers key concepts related to catheter occlusion, including its causes, prevention methods, and symptoms. Understanding these aspects is crucial for effective management and treatment of patients with indwelling catheters.

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