Vascular Access Clinical Considerations
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Questions and Answers

What is a potential complication of inserting a VAD in an extremity with known thrombus?

  • Improved circulation
  • Reduced risk of infection
  • Increased medication absorption
  • Catheter related thrombosis (correct)

Which condition may increase the risk when placing a VAD in a vessel?

  • Absence of prior surgical history
  • Presence of stenosis (correct)
  • Use of larger gauge catheter
  • Normal syringe used for insertion

Which of the following factors should NOT be considered when inserting a VAD for pediatric patients?

  • Developmental stage
  • Parental preferences (correct)
  • Congenital anomalies
  • Size of veins

What is the implication of repeated venipuncture in adults?

<p>Structural damage to veins (B)</p> Signup and view all the answers

What should be avoided in patients with acute bacteremia before placing a long-term CVAD?

<p>Long-term CVAD insertion (A)</p> Signup and view all the answers

What procedure should be performed to determine if a CVAD is the source of bacteremia?

<p>Blood cultures for time to positivity (A)</p> Signup and view all the answers

Which statement is true about catheter tip placement?

<p>Catheter tip should avoid infusing against the vein wall (D)</p> Signup and view all the answers

What is a typical outcome of catheter movement that causes trauma to vein endothelium?

<p>Formation of a platelet plug (A)</p> Signup and view all the answers

Which device may provide antimicrobial protection when using a CVAD?

<p>A CVAD with antimicrobial/anti-infective protection (B)</p> Signup and view all the answers

Which location is most suitable for VAD insertion in pediatric patients?

<p>Upper extremities in non-ambulatory patients (C)</p> Signup and view all the answers

What is a recommended practice when inserting a VAD in the presence of a fracture?

<p>Use the contralateral side of the fracture. (D)</p> Signup and view all the answers

For patients with morbid obesity, what consideration should be made when selecting a VAD site?

<p>Choose sites easy to maintain dressing integrity. (A)</p> Signup and view all the answers

Which type of catheter is preferred for patients with congenital heart disease?

<p>The smallest catheter with the least number of lumens. (D)</p> Signup and view all the answers

What is important to consider when placing a VAD on the ipsilateral side of a recently implanted AICD?

<p>Consultation with a Cardiologist should be considered. (D)</p> Signup and view all the answers

In the case of Reynaud's Syndrome, what is the advised size of the VAD?

<p>Smallest gauge to accomplish the therapeutic goal. (A)</p> Signup and view all the answers

What is a key consideration for placing a PICC in patients with a Fontan repair?

<p>Preferred placement is on the right side. (D)</p> Signup and view all the answers

What is the preferred catheter placement for patients with a permanent pacemaker?

<p>The contralateral side of the pacemaker. (B)</p> Signup and view all the answers

Which site should be avoided when dealing with an infection?

<p>Ipsilateral side of any wounds. (C)</p> Signup and view all the answers

What should be monitored post VAD placement in patients with implanted devices?

<p>Ensure the device is monitored for lead dislodgement. (A)</p> Signup and view all the answers

When dealing with peripheral vascular diseases, what is the ideal approach to catheter gauge?

<p>Smallest gauge to accomplish the therapeutic goal. (B)</p> Signup and view all the answers

Flashcards

Cellulitis

A condition characterized by inflammation of the skin, typically caused by bacterial infection. It may involve redness, swelling, pain, and warmth.

Wound

Presence of an open wound or break in the skin integrity.

Morbid Obesity

A condition characterized by excessive body fat mass, making it more challenging to access veins for vascular access.

Fontan Anastomosis

A congenital heart condition where blood flows directly from the right ventricle to the aorta, bypassing the lungs.

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Pacemaker

A medical device implanted in the chest to regulate heart rhythm and prevent arrhythmias.

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AICD (Automatic Implanted Cardioverter Defibrillator)

A medical device implanted in the chest to deliver electrical shocks to correct life-threatening arrhythmias.

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Raynaud's Syndrome

A condition characterized by episodic narrowing of blood vessels, leading to reduced blood flow and sometimes pain or numbness.

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Peripheral Vascular Disease

A condition representing narrowing of peripheral arteries, causing reduced blood flow to the limbs.

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Thrombosis

Formation of a blood clot inside a blood vessel, potentially blocking blood flow.

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PICC (Peripherally Inserted Central Catheter)

A central venous access device (CVAD) placed in the upper arm, typically through the basilic or brachial vein, and extending into the superior vena cava.

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VAD Placement and Thrombus

VAD placement should be avoided in the extremity or location where a known thrombus is present due to increased risk of catheter-related thrombosis and complications of compromised circulation.

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Choosing the Smallest Gauge

When selecting a VAD, prioritize the smallest gauge catheter that can achieve the desired therapeutic outcome. Smaller gauges reduce the risk of thrombosis and vein irritation.

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Contraindications for SVC VAD

The SVC (Superior Vena Cava) should be avoided for VAD placement if there's been prior injury, surgery, radiation therapy, or a history of central occlusion like SVC syndrome. Stenosis in major upper thoracic vessels is also a contraindication.

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VAD Placement and Stenosis

Stenosis, or narrowing, of the SVC or IVC may make it difficult to advance the VAD catheter to the optimal position. Stenosis can occur on one or both sides.

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Risks of VAD in Stenotic Vessels

Placing a VAD in a stenosed vessel increases the risk of blood clots (thrombosis) and infection. The compromised blood flow and potential damage to the vessel wall contribute to these risks.

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VAD and Blood Stream Infections

Sepsis and bacteremia (bacteria in the bloodstream) are serious complications associated with VADs. These infections can originate from the VAD itself.

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Protecting Against VAD Infections

When possible, use CVADs equipped with antimicrobial or anti-infective protection to help prevent infections. If not available, consider a PIV (peripheral intravenous) if medication properties allow.

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VADs and Acute Infections

In cases of acute bacteremia or sepsis, short-term CVADs may be necessary for volume resuscitation, medication administration, and antibiotic delivery. Avoid placing long-term CVADs until the infection resolves.

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Pediatric Considerations for VAD Placement

VAD insertion sites in children may be limited due to congenital anomalies or small veins. Avoid VADs in the lower extremities of crawling or walking children to prevent dislodgement.

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Cumulative Vein Damage and Repeated Venipuncture

Repeated venipuncture, especially in the forearms and hands, can cause damage to the vein walls, leading to cumulative damage and inflammation. Caustic infusates further exacerbate this damage.

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Study Notes

Skin Conditions

  • Cellulitis, burns, fractures, or wounds near insertion site may complicate procedures
  • Poor skin integrity increases infection risk
  • Appropriate care and maintenance of the insertion site are vital

Patient Body Habitus

  • Morbid obesity presents challenges for VAD insertion
  • Careful consideration of insertion site and stability is necessary

Cardiac Conditions and Implanted Devices

  • Congenital heart disease (CHD) like Glenn or Fontan anastomosis necessitates specific insertion strategies to minimize complications
  • Permanent pacemakers, AICDs, and other implanted devices require careful planning to avoid complications
  • Placement on the contralateral side to existing devices is often preferential

Vascular Conditions

  • Reynaud's Syndrome and Peripheral Vascular Disease are conditions that impact vascular access
  • Thrombosis increases risk of catheter-related complications
  • Using smallest possible gauge catheter to minimize complications
  • Consider contralateral placement when possible

Blood Stream Infections

  • Sepsis may require temporary VAD placement for volume resuscitation, antibiotics, and inotropic drugs
  • Placement may need to be avoided until acute bacteremia/sepsis is resolved

Pediatric Considerations

  • Age and developmental stage influence VAD site selection and insertion technique
  • Congenital anomalies limit VAD site options and potentially increase risk factors
  • Structural damage begins with vein wall puncture for device insertion
  • Activation of blood factors develops fibrin over the platelet plug at the puncture site
  • Cumulative damage occurs from repeated or ongoing caustic exposure

pH Scale

  • Changes in pH can affect vascular tissue and compromise the integrity of the insertion site
  • Extreme levels of acidity or alkalinity impact the chemical nature of the body's environment

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Vascular Access (PDF)

Description

This quiz covers critical situations regarding vascular access, including skin integrity, body habitus, cardiac conditions, and vascular diseases. Understanding these aspects is crucial for minimizing complications during insertion procedures. Prepare to evaluate various patient factors that can impact vascular access effectiveness.

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