Vascular Access Device Selection

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Questions and Answers

What is the maximum recommended duration for therapies using peripheral IV catheters?

3 days

14 days

10 days

6 days (correct)

Which of the following contraindications applies to the use of peripheral IV catheters?

Placement in an arm without prior injuries

Use in lower extremities

Failure to monitor clinician administration

Infusions with osmolarity > 900 mOsm/L (correct)

What is advised regarding the selection of a site for a peripheral IV catheter insertion?

Prefer veins in lower extremities

Utilize metacarpals first

Select veins with high phlebitis risk

Avoid areas of flexion (correct)

Which technique is NOT typically used for inserting peripheral IV catheters?

Spirometry technique Signup and view all the answers

In which scenario is the administration of vesicant medication allowable with peripheral IV catheter use?

Single dose under clinician monitoring Signup and view all the answers

What is the primary relationship between gauge size and the internal diameter of a catheter?

Larger gauge sizes correspond to smaller internal diameters. Signup and view all the answers

Which statement accurately describes the tensile strength of silicone compared to polyurethane?

Polyurethane has a higher tensile strength than silicone. Signup and view all the answers

What is a key consideration when using alcohol in relation to polyurethane catheters?

Alcohol acts as a solvent and may cause degradation. Signup and view all the answers

Which of the following best explains the use of radiopaque materials in IV devices?

To facilitate visualization of catheter and emboli in imaging. Signup and view all the answers

What is the recommended practice regarding needle usage after the first site puncture?

Needles should be discarded to avoid contamination. Signup and view all the answers

Which factor is NOT typically considered during the selection of a vascular access device?

Patient's specific insurance coverage Signup and view all the answers

What is a primary reason for early consultation between the vascular access specialist and the patient?

To achieve optimal outcomes in device placement Signup and view all the answers

In pediatric patients, which of the following is NOT a consideration for vascular access device selection?

Child's favorite activities Signup and view all the answers

Which statement about French Scale is correct?

Fr size equals external diameter in mm multiplied by 3. Signup and view all the answers

Why is patient-specific vascular assessment critical in vascular access insertion?

To avoid unnecessary pain from repeated venipuncture. Signup and view all the answers

Which procedure would typically require vascular access?

Total parenteral nutrition (TPN) Signup and view all the answers

What aspect is particularly important when assessing pediatric patients for vascular access?

Child's cognitive ability Signup and view all the answers

Which of the following is NOT a complication associated with vascular access?

Diminished appetite Signup and view all the answers

Which of the following is a reason to contraindicate the use of a peripheral IV catheter?

Therapies expected to last more than 6 days. Signup and view all the answers

Which of the following veins is considered the least appropriate for commonly administering peripheral IV catheters?

Veins in the lower extremities Signup and view all the answers

When selecting a site for a peripheral IV catheter, which area should be specifically avoided?

Arm with compromised circulation Signup and view all the answers

What is an essential consideration when using ultrasound for peripheral IV catheter placement?

The depth of the vessel and catheter length. Signup and view all the answers

Which type of medications is accepted for administration through a peripheral IV catheter with monitoring?

Single dose of vesicant medications under supervision Signup and view all the answers

How does the relationship between gauge size and internal diameter of a catheter affect infusion rates?

Larger gauges enable higher infusion rates because they have a smaller internal diameter. Signup and view all the answers

Which characteristic distinguishes polyurethane catheters from silicone catheters in terms of flexibility and tensile strength?

Polyurethane catheters possess higher tensile strength than silicone catheters. Signup and view all the answers

What is a critical factor to consider when using ethanol lock with polyurethane catheters?

Specific formulations of polyurethane may degrade when exposed to alcohol. Signup and view all the answers

Which size range represents central venous catheters effectively for adult use?

12 Fr to 15 Fr Signup and view all the answers

What potential issue can arise from using the same needle for repeated attempts at puncture?

Micro tissue damage, which can increase the risk of infection. Signup and view all the answers

What is a critical factor to consider during early consultation between the vascular access specialist and the patient?

Promoting vessel preservation and health Signup and view all the answers

Which factor does NOT impact the device selection for pediatric patients?

Family income level Signup and view all the answers

Which of the following is NOT a clinical indication for vascular access?

Routine physical exams Signup and view all the answers

What aspect of a patient's understanding is important before vascular access insertion?

Knowledge of prescribed therapy risks and benefits Signup and view all the answers

What does the French Scale measure in regards to vascular access devices?

External diameter of the catheter Signup and view all the answers

Which of the following should be assessed in pediatric patients before vascular access insertion?

Cognitive ability Signup and view all the answers

Which statement regarding hydration and vascular access is accurate?

Hydration is a primary indication for vascular access devices Signup and view all the answers

What is a significant challenge in vascular access for pediatric patients?

Smaller vessel size, making visualization difficult Signup and view all the answers

Study Notes

Device Selection - General

Early consultation between the vascular access specialist and the patient/family is crucial for optimal outcomes.
Patient variables (at admission) and projected therapies are reviewed to promote timely and appropriate vascular access insertion.
Vascular access insertion aims to minimize complications and ensure safe infusion delivery.
Patient preferences, daily activities, lifestyle, and employment are considered.
Patient understanding of the diagnosis and therapy is assessed.

Pediatric Considerations

Device selection may be limited in children due to smaller vessel size.
Multiple attempts, previous complications, and developmental stage are factors.
Clinicians for pediatric vascular access must have specific training.
Minimizing venipuncture attempts is vital for pain and anxiety reduction.
Factors including age, size, vascular sites, reason for therapy and duration, activity, and mobility, cognitive ability, fine and gross motor skills, and body image must be considered.

Indications for Vascular Access

Hydration
Medication administration
Parenteral nutrition (TPN or PPN)
Chemotherapy
Blood products
Clinical/diagnostic needs
Hemodynamic monitoring
Plasmapheresis/Aquapheresis/Hemodialysis
Frequent blood sampling (difficult access patients)
Therapeutic phlebotomy

Device Facts

French scale (Fr): measures external catheter diameter. Larger Fr number, larger diameter. Central venous catheter sizes range from 1.2 Fr (neonatal PICCs) to 15 Fr (dialysis catheters).
Gauge (g or ga): measures internal catheter diameter. Smaller gauge number, larger internal diameter. Higher infusion rates are associated with larger gauge catheters.
Needle characteristics: Single use, intended for tissue piercing once. Repeated attempts can damage tissue, cause contamination, and dull the needle.
Catheter Materials: All IV devices in the USA are radiopaque.

Silicone

Soft, biocompatible polymer
Extremely flexible
Lower tensile strength (compared to polyurethane) resulting in a higher inner/outer diameter ratio
Not affected by chemicals such as alcohol

Polyurethane

Biocompatible urethane-based polymer material
Various formulations used in peripheral and central venous catheters
Alcohol can act as a solvent on some types of polyurethane catheters, possibly causing degradation; consider manufacturer instructions before use with ethanol locks.

Peripheral Catheters

Short and long peripheral IV catheters exist in current clinical practice.
Length ranges from 0.56" to 2.5" and 14mm to 10cm
Common insertion methods: catheter-over-needle, accelerated, modified Seldinger.

Indications/Contraindications

Indications: Infusions projected for 6 days or less; Non-irritant and non-vesicant medications/solutions; Single dose (non-continuous) vesicant administration (clinician monitored).
Contraindications: Therapies for more than 6 days; Osmolarity >900 mOsm/L; Infusates with high phlebitis risks; Placement in arms with thrombosis, fractures, trauma, impaired circulation, mastectomy, or A/V fistula (graft).

Insertion Procedures and Supplies

Follow manufacturer's instructions.
Aseptic non-touch technique
Skin antisepsis
Limited attempts per healthcare provider (two attempts per individual, up to 4 before referring to a vascular access specialist)
Successful access unlikely based on clinician assessment, refer to a more experienced clinician or specialist.
Select smallest possible gauge (for delivery of prescribed therapy).
Consider visualization technology.
Peripheral IV catheter
Skin antiseptic agent
Gloves
Extension set
Needleless connector
Normal saline (NS) flush solution
Transparent dressing (TSM) or antimicrobial dressing
Skin adhesive
Tissue adhesive
Skin protectant
Engineered stabilization device

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Description

This quiz focuses on the essential considerations for selecting vascular access devices, particularly in pediatric patients. It addresses the importance of early consultations, patient variables, and the minimization of complications during insertion. Understanding both adult and pediatric patient needs is crucial for optimizing vascular access outcomes.