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</p> Signup and view all the answers

    Why is a normal saline flush used during port access?

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

    What must be done before any infusion through a port?

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

    Which veins can be accessed for central venous catheter placement?

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

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

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

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

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

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

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

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

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

    What is the purpose of the cuff on tunneled catheters?

    <p>To secure the catheter within tissue</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.</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.</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.</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.</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.</p> Signup and view all the answers

    Which procedure is applicable when determining catheter tip location?

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

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

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

    What are the potential contraindications for implanting a venous port?

    <p>Severe coagulopathy</p> Signup and view all the answers

    Which veins are appropriate for central venous catheter placement?

    <p>Femoral vein and jugular vein</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.</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</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.</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.</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</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</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</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</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</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</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</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</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</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</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</p> Signup and view all the answers

    Which intervention enhances drug absorption in subcutaneous infusions?

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

    Which of the following medications is appropriate for subcutaneous infusion?

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

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

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

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

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

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

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

    Which option is a contraindication for intraosseous access?

    <p>Trauma or fracture in the area of access</p> Signup and view all the answers

    What is an appropriate alternative site for intraosseous access?

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

    What substance is recommended for analgesia during intraosseous access?

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

    What should be done prior to intraosseous needle insertion?

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

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

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

    Which factor must be assessed before administering subcutaneous infusion?

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

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

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

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

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

    What is a significant contraindication for intraosseous access?

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

    Which site is preferred for intraosseous access in adults?

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

    How long can intraosseous access be maintained in the US?

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

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

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

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

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

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

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

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

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

    What is the primary use of a pediatric umbilical catheter?

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

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

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

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

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

    What is a key indication for using an arterial catheter?

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

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

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

    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
    Vascular Access Board Certification Study Guide PDF
    ava 28-31.PNG

    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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