Pediatric Vascular Access Techniques
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Questions and Answers

What is the recommended site for a port implantation?

  • Forehead
  • Lower back
  • Upper chest (correct)
  • Inner thigh

Which procedure is necessary to confirm catheter tip location after port implantation?

  • Physical examination
  • Blood draw
  • Ultrasound imaging
  • Fluoroscopy (correct)

What type of needle is used for accessing an implanted venous port?

  • Biopsy needle
  • Hollow bore needle
  • Coring needle
  • Non-coring needle (correct)

What is an important consideration when selecting a needle for port access?

<p>The needle length must not exceed the port septum internally (D)</p> Signup and view all the answers

Why is a normal saline flush used during port access?

<p>To prevent clot formation (A)</p> Signup and view all the answers

What must be done before any infusion through a port?

<p>Obtain a free-flowing blood return (C)</p> Signup and view all the answers

What should pediatric clinicians verify regarding an implanted port as a child grows?

<p>The internal catheter tip position (D)</p> Signup and view all the answers

Which of the following is NOT a supply needed for the placement of a port?

<p>Needleless connector (A)</p> Signup and view all the answers

What is the optimal tip location for a tunneled central venous catheter inserted via the femoral vein?

<p>In the inferior vena cava above the diaphragm (D)</p> Signup and view all the answers

Which action should be avoided prior to any infusion in relation to a central venous catheter?

<p>Hub the catheter (B)</p> Signup and view all the answers

For pediatric patients, what is the optimal tip location for lower extremity catheter insertion in those under 12 months of age?

<p>Between levels 19-111 (D)</p> Signup and view all the answers

Which of the following is NOT a contraindication for the implantation of a venous port?

<p>Long term intermittent therapy (A)</p> Signup and view all the answers

Which veins can be accessed for central venous catheter placement?

<p>Both A and B (A)</p> Signup and view all the answers

What aspect must be considered for the comfort related to the location of the implanted venous port?

<p>Depth must be shallow enough for safe palpation and insertion (D)</p> Signup and view all the answers

What is a potential benefit of adding Heparin to the infusate for central venous catheters?

<p>Decreases catheter occlusion (C)</p> Signup and view all the answers

What does the marking on a tunneled central venous catheter indicate?

<p>Farthest point to advance the catheter (D)</p> Signup and view all the answers

What is the preferred alternative vein for catheter insertion in very young children to avoid complications?

<p>Jugular vein (D)</p> Signup and view all the answers

Which catheter is preferred for non-acute care settings when dealing with pediatric patients?

<p>PICC lines (C)</p> Signup and view all the answers

What is a contraindication for placing a tunneled central venous catheter?

<p>Presence of a bloodstream infection (B)</p> Signup and view all the answers

What is the optimal tip location for catheter insertion in lower extremities for patients under one year old?

<p>Between levels 19-111 (B)</p> Signup and view all the answers

What may be added to the infusate to help decrease catheter occlusion?

<p>Heparin (B)</p> Signup and view all the answers

Which of the following is an indication for a tunneled central venous catheter?

<p>Difficult intravenous access patients (B)</p> Signup and view all the answers

Which insertion site is discouraged for non-tunneled CVADs outside acute care settings?

<p>Jugular vein (B)</p> Signup and view all the answers

What is the purpose of the cuff on tunneled catheters?

<p>To secure the catheter within tissue (B)</p> Signup and view all the answers

What should be done to ensure safe access to an implanted venous port?

<p>Select a sterile site that allows dressing maintenance. (D)</p> Signup and view all the answers

What factors determine the choice of needle length during port access?

<p>Body habitus and the specific port design. (A)</p> Signup and view all the answers

What is a reason for confirming catheter tip location after implantation?

<p>To minimize the risk of complications during use. (B)</p> Signup and view all the answers

What is important to educate a patient about their implanted venous port?

<p>The appropriate needle size for future access. (C)</p> Signup and view all the answers

What is a crucial step to follow during the accessing of an implanted port?

<p>Ensure free-flowing blood return before infusion. (C)</p> Signup and view all the answers

Which procedure is applicable when determining catheter tip location?

<p>Fluoroscopy or radiographic imaging. (A)</p> Signup and view all the answers

Which supply is essential for the placement of an implanted venous port?

<p>Catheter tip location technology. (A)</p> Signup and view all the answers

What is a common consideration for pediatric patients regarding their implanted ports?

<p>The catheter tip position must be verified regularly. (A)</p> Signup and view all the answers

What are the potential contraindications for implanting a venous port?

<p>Severe coagulopathy (B), Severe burns affecting insertion site (C)</p> Signup and view all the answers

Which veins are appropriate for central venous catheter placement?

<p>Femoral vein and jugular vein (A), Subclavian vein and axillary vein (C)</p> Signup and view all the answers

What should be ensured about a tunneled central venous catheter prior to infusion?

<p>A free-flowing blood return must be obtained. (A)</p> Signup and view all the answers

Which of the following represents the optimal tip location for a tunneled central venous catheter?

<p>Above the diaphragm in the inferior vena cava (C), At the junction of the right atrium and superior vena cava (D)</p> Signup and view all the answers

What is a critical aspect to note for pediatric patients regarding catheter tip location?

<p>It must be assessed as the child grows. (B)</p> Signup and view all the answers

What is a primary consideration when accessing an implanted venous port?

<p>The location should allow safe palpation of the port. (A)</p> Signup and view all the answers

Which option is an indication for the use of a tunneled central venous catheter?

<p>Infusions projected to last for months (A)</p> Signup and view all the answers

What must be maintained during the securement of a tunneled venous catheter?

<p>Proper application of an antimicrobial disc (C)</p> Signup and view all the answers

What is a common contraindication for inserting a tunneled central venous catheter?

<p>Presence of a bloodstream infection (A)</p> Signup and view all the answers

Which veins are recommended for central venous access in pediatric critical care units?

<p>Jugular vein and femoral vein (C)</p> Signup and view all the answers

What is the optimal catheter tip location for lower extremity insertion in patients less than one year of age?

<p>Between levels 19-111 (D)</p> Signup and view all the answers

What is a primary reason to avoid the use of non-tunneled CVADs in jugular and femoral veins outside of acute care settings?

<p>Challenges in catheter stabilization and air embolism risk (D)</p> Signup and view all the answers

Which of the following is an advantage of adding Heparin to the infusate in central venous catheters?

<p>Reduces the risk of catheter occlusion (C)</p> Signup and view all the answers

Why are tunneled catheters with cuffs used in central venous access?

<p>To secure the catheter in place and promote healing (D)</p> Signup and view all the answers

Which type of intravenous access is discouraged for pediatric patients in non-acute care settings?

<p>Non-tunneled CVADs (B)</p> Signup and view all the answers

Which factor should be assessed while selecting an appropriate catheter size for pediatric vascular access?

<p>Vein health and patency as well as catheter to vein ratio (A)</p> Signup and view all the answers

What is the primary advantage of using subcutaneous infusion over intravascular drug administration?

<p>Offers a safe and cost-effective alternative (A)</p> Signup and view all the answers

Which intervention enhances drug absorption in subcutaneous infusions?

<p>Adding human recombinant hyaluronidase (B)</p> Signup and view all the answers

Which of the following medications is appropriate for subcutaneous infusion?

<p>Insulin (B)</p> Signup and view all the answers

What is a primary contraindication for placing a subcutaneous infusion device?

<p>Poor tissue integrity at the site (C), Inadequate subcutaneous tissue (D)</p> Signup and view all the answers

Which site is frequently recommended for intraosseous access in pediatric patients?

<p>Distal femur (D)</p> Signup and view all the answers

What is the expected impact on the onset of action for medications administered subcutaneously compared to intravenously?

<p>Slower onset with subcutaneous administration (D)</p> Signup and view all the answers

What is the proper angle for placing a device to access subcutaneous tissue?

<p>90° angle (D)</p> Signup and view all the answers

Which fluid is recommended as a running line with the aid of a pressure bag for pediatric patients?

<p>Normal saline (C)</p> Signup and view all the answers

What is the maximum dwell time for intraosseous access in the US?

<p>24 hours (A)</p> Signup and view all the answers

Which option is a contraindication for intraosseous access?

<p>Trauma or fracture in the area of access (B), Presence of bone disease (C)</p> Signup and view all the answers

What is an appropriate alternative site for intraosseous access?

<p>Sternum (A)</p> Signup and view all the answers

How should the proximal humerus be positioned for intraosseous insertion?

<p>Adducted with the hand across the abdomen (D)</p> Signup and view all the answers

What substance is recommended for analgesia during intraosseous access?

<p>Lidocaine 2% (preservative and epinephrine free) (A)</p> Signup and view all the answers

Which of the following statements about intraosseous needle insertion is true?

<p>Only one attempt is allowed in the same bone every 24 hours. (C)</p> Signup and view all the answers

What should be done prior to intraosseous needle insertion?

<p>Conduct site disinfection and use aseptic technique (A)</p> Signup and view all the answers

Which of these is not a common site for intraosseous access?

<p>Scapula (A)</p> Signup and view all the answers

What is a key advantage of using subcutaneous infusion over intravascular drug administration?

<p>Lower risk of infection (B)</p> Signup and view all the answers

What should be done to facilitate drug absorption in subcutaneous infusions exceeding 1000 mL?

<p>Add human recombinant hyaluronidase (C)</p> Signup and view all the answers

Which factor must be assessed before administering subcutaneous infusion?

<p>Tissue integrity at the site (A)</p> Signup and view all the answers

What is a common consideration when selecting a site for subcutaneous infusion in pediatric patients?

<p>Amount of subcutaneous fat (D)</p> Signup and view all the answers

What is the recommended angle for placing an access device into subcutaneous tissue?

<p>90° angle (A)</p> Signup and view all the answers

What complication can arise from using an inappropriate site for subcutaneous infusion?

<p>Delayed absorption (C)</p> Signup and view all the answers

When should isotonic fluid infusions via subcutaneous routes be managed using a gravity system?

<p>When less than 500 mL is administered (C)</p> Signup and view all the answers

What is a significant contraindication for intraosseous access?

<p>Previous orthopedic procedure at the site (D)</p> Signup and view all the answers

Which site is preferred for intraosseous access in adults?

<p>Proximal humerus (D)</p> Signup and view all the answers

How long can intraosseous access be maintained in the US?

<p>24 hours (C)</p> Signup and view all the answers

What should be done to minimize pain during fluid administration via intraosseous access?

<p>Administer lidocaine 2% (A)</p> Signup and view all the answers

What is the maximum number of attempts allowed for intraosseous access in the same bone?

<p>One attempt per 48 hours (C)</p> Signup and view all the answers

Which of the following sites is considered an alternative for intraosseous access?

<p>Femur (A)</p> Signup and view all the answers

What technique should be implemented prior to starting an intraosseous procedure?

<p>Aseptic technique and site disinfection (B)</p> Signup and view all the answers

Which of the following factors should be considered when selecting a needle for intraosseous access?

<p>Patient weight and anatomy (C)</p> Signup and view all the answers

What is a common indication for using a pulmonary artery catheter?

<p>Evaluating cardiovascular and/or pulmonary function (B)</p> Signup and view all the answers

What can a positive Allen's test indicate regarding radial artery puncture?

<p>Lack of collateral circulation (D)</p> Signup and view all the answers

Which of the following is NOT a contraindication for the insertion of an aquapheresis catheter?

<p>Recent history of venous thrombosis (A)</p> Signup and view all the answers

What is the primary use of a pediatric umbilical catheter?

<p>Fluid and medication administration (C)</p> Signup and view all the answers

How can inadequate collateral circulation be assessed before radial artery catheter insertion?

<p>Modified Allen's test (B)</p> Signup and view all the answers

Which of the following indicates a contraindication for a pulmonary artery catheter insertion?

<p>Mitral stenosis (A)</p> Signup and view all the answers

What is a key indication for using an arterial catheter?

<p>General blood sampling (B)</p> Signup and view all the answers

What may indicate the need for pediatric umbilical catheter placement to be avoided?

<p>Necrotizing enterocolitis (D)</p> Signup and view all the answers

Flashcards

Implanted Venous Port

A type of central venous catheter that is implanted under the skin and accessed with a needle.

Exit Site

The area where the catheter exits the skin.

Optimal Tip Location of a Central Venous Catheter

The tip of the catheter should be located in the right atrium, the superior vena cava, or the inferior vena cava above the diaphragm, depending on the insertion site.

Zero Mark on a Central Venous Catheter

The outermost mark on a central venous catheter, which indicates the maximum depth of insertion. Any further advancement could damage the vessel or heart.

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Catheter Tip Confirmation

A procedure to ensure that the catheter is properly positioned by visually tracking its path through the veins.

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Free-Flowing Blood Return

A safety measure to verify that the catheter is properly placed before administering any medications or fluids.

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Severe Coagulopathy

A condition characterized by a reduced ability of the blood to clot, making the patient more prone to bleeding.

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Severe Uncontrolled Sepsis

A serious infection that can spread rapidly throughout the body, making it dangerous to insert a central venous catheter.

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Why is ultrasound used before CVC insertion?

Ultrasound is used before inserting a central venous catheter (CVC) to assess the vein's health, patency, and size, ensuring a good fit for the catheter.

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Alternatives to standard CVC sites in pediatrics?

The jugular vein is preferred in very young children because it reduces pneumothorax risk. The femoral vein is often used in critical care units due to easier access and lower infection risk compared to the jugular.

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Optimal tip location for lower extremity CVCs in infants?

For lower extremity CVC insertions in children under one year old, aim for the tip location to be between levels 19 and 111, ensuring proper placement.

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How can heparin help with CVCs?

Adding heparin to the IV fluid sometimes helps prevent catheter blockage, but be sure to check for compatibility, as not all fluids mix well with heparin.

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Why are non-tunneled CVCs discouraged in ambulatory pediatric patients?

For pediatric patients, PICC lines or tunneled CVCs are preferred over non-tunneled CVCs in the jugular or femoral veins outside of acute care settings due to stabilization challenges and air embolism risks.

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What is a tunneled CVAD and what is it used for?

A tunneled central venous catheter (CVAD) is a long-term solution for IV access, used for medications, nutrition, fluids, or blood products.

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Contraindications for placing a tunneled CVAD?

Bloodstream infection, severe coagulopathy (blood clotting issues), and cellulitis at the intended insertion site are all reasons to avoid placing a tunneled CVAD.

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Common insertion sites for tunneled CVADs?

The axillary and subclavian veins are common insertion sites for tunneled CVADs, offering good access and stability.

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Port Placement: Dressing Consideration

The site chosen for port placement should allow for secure application and maintenance of the dressing, even while accessing the port.

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Port Implantation Method

Port implantation is either done during a surgical procedure or by Interventional Radiology.

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Port Placement Location

The port can be placed in the arm, upper chest, or lower abdomen, depending on the vein accessed.

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Port Attachment

The port is securely attached to the body's fascia using sutures.

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Port Tip Verification

The tip of the catheter is visualized with fluoroscopy, EKG/Doppler, or an ENG to ensure it's in the correct position.

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Power/Pressure Injection

All vascular access devices, including ports, can be used for injecting liquids under power/pressure.

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Non-coring Needle

Access needles should be non-coring, meaning they don't remove tissue, to avoid damaging the port's septum.

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Blood Return Check

Prior to any infusion, check for free-flowing blood return through the port to ensure the access is clear and functional.

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Ultrasound Assessment for Pediatric Vascular Access

Using ultrasound to visualize and assess the vein's health, patency, and size before placing a catheter.

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Preferred Vein Selection in Pediatric Vascular Access

The jugular vein is preferred in very young children to avoid pneumothorax, while the femoral vein is commonly used in critical care due to its ease of access and lower infection risk.

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Optimal Tip Location for Lower Extremity Catheters in Infants

The optimal tip location for lower extremity catheter insertions in infants is between levels 19 and 111.

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Heparin Usage in Pediatric Vascular Access

Adding heparin to the infusate may decrease catheter occlusion, but it is important to check for compatibility before mixing.

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Non-Tunneled CVADs in Ambulatory Pediatric Patients

Non-tunneled CVADs (central venous access devices) are discouraged in ambulatory pediatric patients due to difficulties stabilizing the catheter and increased risk of air embolism.

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Indications for Tunneled CVADs

Tunneled CVADs are used for long-term infusions, hemodialysis, apheresis, medication administration, and TPN/PPN.

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Contraindications for Tunneled CVADs

Presence of a bloodstream infection, severe coagulopathy, and cellulitis affecting the insertion site are contraindications for placing a tunneled CVAD.

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What does the zero mark on a CVC indicate?

The zero mark on a central venous catheter indicates the maximum depth the catheter should be advanced. Further advancement increases risk of vessel or heart damage.

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Why is free-flowing blood return important before CVC infusions?

Before infusing any medication or fluids through a CVC, ensure the catheter is properly placed by checking for free-flowing blood return. This signifies a clear path for the fluids.

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How is CVC tip location confirmed before infusion?

Confirming the tip's location is crucial before any CVC infusion. It can be done using ECG/Doppler technology, radiographs, or fluoroscopy, ensuring the catheter is properly positioned.

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What is the optimal tip location for lower extremity CVCs in infants?

In pediatric patients under 12 months, the optimal tip location for lower extremity inserted CVCs is between levels 19 and 111, ensuring proper placement and avoiding complications.

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What is an implanted venous port and what's its common use?

For long-term medication or fluid therapy, implanted venous ports offer a durable and convenient access point.

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What are the contraindications for placing an implanted venous port?

Severe coagulopathy, severe uncontrolled sepsis, burns or cellulitis at the insertion site, and cachexia are conditions that make implanted venous ports unsuitable.

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What's important to consider regarding the depth of implanted venous ports?

The depth of the implanted venous port should be shallow enough for safe, non-coring needle insertion to access the port septum.

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Intraosseous Access

A medical procedure that provides access to the bone marrow for fluid or medication delivery, often used in emergency situations for infants and children.

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Subcutaneous Infusion

The administration of medications or fluids directly into the subcutaneous tissue, a layer below the skin.

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Hyaluronidase

An enzyme that helps reduce the viscosity of the extracellular matrix, facilitating faster absorption of medications from subcutaneous infusions.

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Subcutaneous Tissue

The preferred site for subcutaneous infusion devices, chosen for its abundance of fatty tissue.

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Subcutaneous Device Placement

The placement of an infusion device in the subcutaneous tissue, with the catheter tip ending in the space between the dermis and muscle.

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Indwelling Device for Subcutaneous Infusion

Infusion devices designed for continuous access, using indwelling plastic canulas instead of steel needles.

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Intraosseous Infusion

A method for delivering medications or fluids directly into the bone marrow.

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What is Intraosseous (IO) Access?

A medical procedure that involves inserting a needle into the bone marrow for rapid fluid or medication administration in emergency situations.

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When is IO access indicated?

IO access is indicated for rapid fluid and medication delivery in emergency situations when venous access is impossible or difficult. Common indications include cardiac arrest, hypovolemia, severe dehydration, and drug overdose.

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What are the contraindications for IO access?

Trauma or fracture at the site of insertion, bone disease, compartment syndrome, infection at the insertion site, inability to identify landmarks, prior IO access within 48 hours, previous orthopedic procedure at the site, and prosthetic limbs are all contraindications.

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Where are common IO access sites?

The proximal humerus (preferred for adults), proximal and distal tibia (away from the growth plate), sternum, iliac crest, and femur are commonly used sites for IO access, as long as they meet the manufacturer's instructions.

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What are some general considerations for IO access?

Prior to insertion, disinfect the site and adhere to proper aseptic techniques. Only attempt IO access once in the same bone per 48 hours. Use manufacturer-recommended stabilizing devices to prevent dislodgement. Administer lidocaine (2%, preservative-free, epinephrine-free) for pain management during fluid and medication administration.

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Why is aseptic technique important for IO access?

Aseptic technique is crucial for minimizing infection risk. Properly disinfect the insertion site with an appropriate antiseptic solution and maintain sterile conditions throughout the procedure.

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How do you position the patient for IO access?

To position for proximal humerus access, the arm should be adducted, with the hand across the abdomen and the arm tight to the body. This rotation helps protect the biceps tendon from needle damage. An alternate method involves internal rotation of the arm for the same protective effect. For proximal and distal tibia access, extend the lower extremity into neutral alignment.

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Describe the insertion procedure for IO access.

The insertion procedure involves selecting the appropriate needle set based on the patient's weight, anatomy, and tissue depth, following manufacturer recommendations.

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What is IO access?

Intraosseous (IO) access is a medical procedure involving inserting a needle into the bone marrow for rapid delivery of fluids or medications during emergencies.

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Allen's Test

A test used to assess the adequacy of collateral circulation in the hand, primarily focused on the radial artery.

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Arterial Catheter

A type of catheter inserted into an artery, most commonly the radial artery, for monitoring blood pressure, obtaining blood gas samples, and performing blood sampling.

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Pulmonary Artery Catheter

A catheter inserted into the pulmonary artery to measure hemodynamics and evaluate cardiovascular and pulmonary function, crucial for assessing fluid requirements and monitoring cardiac function.

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Aquapheresis Catheter

A type of peripheral venous access device used for ultrafiltration therapy, primarily to remove excess fluids and sodium from the bloodstream.

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Pediatric Umbilical Catheter

A catheter inserted into an infant's umbilical vessels (two arteries and one vein) for fluid and medication administration, blood sampling, and nutrition delivery.

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What is required for a complete insertion procedure of an arterial catheter?

The procedure to insert a catheter into an artery requires observing adequate collateral circulation, typically assessed with the Allen's Test.

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What are the common sites for arterial catheter insertion?

The most common sites for arterial catheter insertion include the radial, brachial, axillary, dorsalis pedis, and femoral arteries.

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What is a contraindication for a Pulmonary Artery Catheter?

A restrictive heart condition hindering blood flow from the left atrium to the left ventricle makes placing a pulmonary artery catheter unsafe.

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Study Notes

Pediatric Considerations for Vascular Access

  • Thoroughly assess veins using ultrasound to determine vessel health and patency. Select catheter size based on assessment.
  • Jugular vein may be preferred for young children to avoid pneumothorax.
  • Femoral vein is commonly used in pediatric critical care due to ease of insertion and decreased infection risk compared to jugular.
  • Scalp, popliteal, greater/lesser saphenous, and femoral veins are options.
  • For lower extremity insertion in children under one year, optimal tip location is between levels 19-111.
  • Heparin in infusate may decrease catheter occlusion.
  • Non-acute care considerations: use of non-tunneled CVADs in the jugular or femoral veins is discouraged outside the acute care setting; PICC lines or tunneled CVADs are preferred.

Tunneled Central Venous Catheter

  • Indications: prolonged infusions (months/years), hemodialysis/apheresis, medication administration, TPN/PPN, chemotherapy agents, blood/blood components, irritant/vesicant infusions, difficult IV access.
  • Contraindications: bloodstream infection, severe coagulopathy, cellulitis at insertion site.
  • Site/Vessel Selection: axillary and subclavian veins.
  • Supplies: sterile insertion tray, ultrasound and probe, surgical equipment, transparent antimicrobial dressing, normal saline, cuff option for catheter.
  • Additional considerations: the exit site may heal within two to three weeks after tissue attachment has been established, confirm tip location before infusions with ECG, ECG/Doppler, radiograph, or fluoroscopy.

Implanted Venous Port (Peripheral or Torso Location)

  • Indications: prolonged infusions (months/years), long-term intermittent therapy, infusions requiring frequent access.
  • Contraindications: severe coagulopathy, severe/uncontrolled sepsis, burns/cellulitis at intended insertion site, cachexia/low body weight/lack of subcutaneous tissue.
  • Site/Vessel Selection: Peripheral (basilic or cephalic vein) or central (axillary, subclavian, jugular, femoral).
  • Considerations: port comfort, needle depth for access, maintaining dressing integrity during access. Ensure access needle does not protrude excessively.
  • Insertion: scheduled as operative or Interventional Radiology procedure under anesthesia/sedation.
  • Optimal Tip location: CAJ/Upper RA or Inferior Vena Cava (IVC) above the diaphragm.

Power/Pressure Injectable Vascular Access Devices

  • Injectable catheters require clear marking and identification.
  • Made of polyurethane, designed to resist high pressure (e.g., >300 PSI).
  • Used for IV contrast media injection during CT or MRI scans.
  • Verify compatibility with different solution types.

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Related Documents

Pediatric Vascular Access PDF
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Description

This quiz covers essential considerations for vascular access in pediatric patients, including vein assessment using ultrasound and catheter selection. It addresses the specific needs and preferences for various venous sites like jugular and femoral veins. Key indications and contraindications for tunneled central venous catheters are also discussed.

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