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?

Structural damage to veins Signup and view all the answers

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

Long-term CVAD insertion Signup and view all the answers

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

Blood cultures for time to positivity Signup and view all the answers

Which statement is true about catheter tip placement?

Catheter tip should avoid infusing against the vein wall Signup and view all the answers

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

Formation of a platelet plug Signup and view all the answers

Which device may provide antimicrobial protection when using a CVAD?

A CVAD with antimicrobial/anti-infective protection Signup and view all the answers

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

Upper extremities in non-ambulatory patients Signup and view all the answers

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

Use the contralateral side of the fracture. Signup and view all the answers

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

Choose sites easy to maintain dressing integrity. Signup and view all the answers

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

The smallest catheter with the least number of lumens. Signup and view all the answers

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

Consultation with a Cardiologist should be considered. Signup and view all the answers

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

Smallest gauge to accomplish the therapeutic goal. Signup and view all the answers

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

Preferred placement is on the right side. Signup and view all the answers

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

The contralateral side of the pacemaker. Signup and view all the answers

Which site should be avoided when dealing with an infection?

Ipsilateral side of any wounds. Signup and view all the answers

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

Ensure the device is monitored for lead dislodgement. Signup and view all the answers

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

Smallest gauge to accomplish the therapeutic goal. Signup and view all the answers

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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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.