Pediatric IV and Catheter Considerations

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Questions and Answers

What is the optimal tip location for catheters inserted via upper extremity sites?

At the mid-thigh level

In the femoral vein

Above the diaphragm

In the lower third of the SVC (correct)

Which measure is NOT recommended to reduce the risk of air emboli during CVAD placement?

Administering heparin flush before insertion (correct)

Performing skin antisepsis

Using maximum sterile barrier precautions

Positioning the patient in slight Trendelenburg position

What type of device is preferred for vein visualization during catheter insertion?

Digital vein finder

Manual palpation technique

Standard light source

Ultrasound with manufactured probe cover (correct)

Which of the following is NOT considered a relative contraindication for catheter insertion?

History of deep vein thrombosis Signup and view all the answers

Which supplies are essential for a non-tunneled percutaneous venous catheter insertion?

Sterile procedural insertion tray with maximum sterile barrier components Signup and view all the answers

Which veins are preferred for midline catheter placement in the upper arm?

Basilic, Brachial, and Cephalic veins Signup and view all the answers

What is an appropriate indication for using a midline catheter?

Single dose vesicant administration with clinician monitoring Signup and view all the answers

Which technique should be followed for midline catheter insertion?

Aseptic non-touch technique Signup and view all the answers

When is it contraindicated to place a midline catheter?

In an arm with a fracture or infection Signup and view all the answers

What are common vessels selected for midline catheter placement?

Basilic, Brachial, or Cephalic veins Signup and view all the answers

What is the maximum duration vancomycin may be administered via midline catheter?

6 days Signup and view all the answers

Why should PICCs not be trimmed for midline placement?

It risks confusion regarding the type of device Signup and view all the answers

Which of the following is not recommended during midline catheter insertion?

Hubbing the catheter when not specified Signup and view all the answers

Where is the optimal insertion site for adults regarding VAD placement?

Middle 1/3 of the upper arm Signup and view all the answers

Which of the following is NOT a consideration for pediatric vascular access?

Subclavian veins Signup and view all the answers

Which indication would most likely require a non-tunneled catheter?

Short-term central venous access Signup and view all the answers

What is a contraindication for PICC placement?

Location on a paralyzed arm Signup and view all the answers

When should a clinician avoid inserting a second central line on the same side as an existing PICC?

When the catheter to vein ratio is suboptimal Signup and view all the answers

What is an alternative site for vascular access in pediatric patients?

Scalp veins Signup and view all the answers

What is a primary reason for utilizing engineered stabilization devices with VADs?

To secure and stabilize catheter placement Signup and view all the answers

Which is a standard contraindication for central venous access?

Presence of tracheostomy Signup and view all the answers

What is the preferred optimal tip location for catheters inserted via axillary or subclavian sites?

Lower third of the SVC or Cavo atrial junction Signup and view all the answers

Which action is crucial to prevent catheter-related bloodstream infections (CRBSI)?

Adhering to aseptic technique during the procedure Signup and view all the answers

What positioning should a patient be in to minimize the risk of air emboli during CVAD placement?

Slight Trendelenburg position Signup and view all the answers

Which of the following is not considered a relative contraindication for vascular access procedure?

Impacted teeth nearby Signup and view all the answers

What supplies are necessary for a non-tunneled percutaneous venous catheter insertion?

Non-tunneled catheter and normal saline flush solution Signup and view all the answers

Which site is optimal for catheter insertion in adults?

The middle 1/3 of the upper arm Signup and view all the answers

What is a common indication for using a non-tunneled catheter?

Emergent central venous access Signup and view all the answers

In which circumstance should a second central line not be placed on the same side as an existing PICC?

If the patient has chronic kidney disease Signup and view all the answers

Which vein is NOT considered for pediatric vascular access?

Femoral veins Signup and view all the answers

What type of device is essential for managing patient awareness of their VAD?

Education for patients and caregivers Signup and view all the answers

Which scenario is a contraindication for PICC placement?

Placement in an arm with a history of deep vein thrombosis Signup and view all the answers

What is the minimum distance above the antecubital fossa for safe catheter insertion?

2 inches Signup and view all the answers

During which procedure would central venous access most likely be required?

Blood transfusions Signup and view all the answers

Which vein is NOT commonly used for peripheral IV access in infants less than 18 months old?

Deep brachial vein Signup and view all the answers

Which of the following statements about midline catheter use is correct?

It is indicated for infusions projected for more than 6 days. Signup and view all the answers

What is the recommended action if a clinician determines a patient's arm has a chronic kidney disease before catheter placement?

Use an alternative site for IV access. Signup and view all the answers

Which supplies are NOT essential for midline catheter insertion?

Non-sterile gloves Signup and view all the answers

Which practice should be avoided during the insertion of midline catheters?

Trimming the PICC for midline placement Signup and view all the answers

What type of medications can be administered through a midline catheter?

Non-vesicant medications Signup and view all the answers

Which method is recommended for vein visualization before catheter placement?

Adopting a near-infrared technology Signup and view all the answers

What is a primary reason for securing a peripheral IV catheter with an engineered stabilization device?

To prevent movement of the catheter Signup and view all the answers

Study Notes

Pediatric Considerations

Vein selection should use assistive visualization (ultrasound, transillumination, or near-infrared) before placement.
Scalp veins are used in infants under 18 months.
Lower extremity veins (foot, leg) can be accessed in infants (crawling/walking).
Use appropriate comfort measures based on child's age.
Secure peripheral IV catheters with dressings, stabilization, and adhesives.

E. MIDLINE CATHETER

Indications: Infusions > 6 days, non-irritating/non-vesicant medications (single dose, clinician monitored).
Vancomycin can be given via midline for up to 6 days.
Contraindications: Placement in arms with fractures, trauma, infection, circulation compromise, or A/V fistula.
Use basilic, brachial, or cephalic veins in the upper arm, for preferred insertion sites.

F. NON-TUNNELED CATHETER

Indications: Short-term to long-term central venous access; emergent central venous access (not preferred).
Follow all manufacturer instructions for use.
Adhere to aseptic non-touch techniques and maximum barrier precautions.
Avoid trimming PICC for midline placement; consider off-label use.
Do not hub the catheter (unless manufacturer instructions specify).
Supplies include midline catheter, sterile insertion tray, ultrasound, normal saline, and dressings.
Optimal insertion site: Middle 1/3 of upper arm, at least 2 inches above antecubital fossa.
Tip location: Axillary line, distal to shoulder.
Optimal tip location for upper extremity, subclavian, and axillary sites is the lower third of the SVC or the Cavo Atrial Junction (CAJ). The optimal tip location for femoral approach is the Inferior Vena Cava (IVC), above the level of the diaphragm
Educate patients on vascular access device type, emphasizing that midline is NOT a central line.

General Considerations for Catheters

Hydration, total/partial parenteral nutrition (TPN/PPN) or other medications may be administered.
Clinical/diagnostic needs may require vascular access (e.g., blood components, hemodynamic monitoring, diagnostic agents).
Frequent blood needs may require careful assessment.
Placement or insertion should follow all manufacturer's instructions.
Maximum sterile barrier precautions are always needed.
Position patients in the recommended positions (e.g., slight Trendelenburg for CVAD).
Confirm tip location (ECG/Doppler preferred).
Consider antimicrobial catheters for high-risk patients.
Use maximum sterile barrier precautions for catheter placement.
Confirm free flowing blood return before infusion.

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Description

This quiz covers essential considerations for vein selection and catheter placement in pediatric patients. It includes specifics on midline and non-tunneled catheters, along with indications, contraindications, and preferred insertion sites. Perfect for healthcare professionals working with infants and children.