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AVA CERTIFICATION EXAM QUESTIONS
AND ANSWERS: VASCULAR ACCESS
DEVICES
In the presence of a newly placed automatic intracardiac defibrillator or pacemaker - Answer-Avoid PICC insertion on ipsilateral side for six months CVAD insertion in the presents of an IVC filter - Answer-Can Inadvertently trap wires in the filter PIV is indicated for adequate venous availability for indicated therapy. This includes - Answer-Non- vesicants and non- irritants with a pH 5 to 9 and osmolality <600 mOSm/L PICCS can be utilized for - Answer-Chemotherapy, TPN, IV solutions and medication, blood products, plasmapheresis, hemodialysis, diagnosing, frequent blood sampling. Power Injectable devices are made of polyurethane and withstand high pressure of >300 pounds per square inch to be used during - Answer-CT or MRI scan Tunneled CVAD may be indicated for infants and toddlers receiving - Answer-TPN Axillary lymph node dissection including sentinel node biopsy, requires special considerations with vascular access placements - Answer-Use contralateral arm for PIV or PICC placement.
In morbid obesity the most appropriate vein selection may be - Answer-The cephalic vein. Ultrasound appearance of a target vein that changes in size from large to small and back again as you move up the arm - Answer-May represent venous dilatation from a distal stenosis or occlusion How does one measure for PICC placement? - Answer-Position arm at 90 degree angle. Measure from planned insertion site to the right Clavicular head, Then down to the third intracoastal space. Land-marked measuring techniques have reported failure and complications as high as - Answer-30 percent and 18.8 percent respectively Catheter-related infections most often result from - Answer--contamination of the central venous catheter -contamination of the insertion site -break in sterile technique during insertion Maximum sterile barrier protection may reduce the incidence of - Answer-Catheter contamination and CLABSI Chlorhexidine with alcohol is superior to - Answer-Povidone/iodine or isopropyl alcohol How should Chlorhexidine be applied? - Answer-Friction on clean skin for 30 seconds, then allow to dry completely.
PICC CATHETER
Phlebitis pain, redness, swelling, can appear - Answer-anywhere along the cannulated vein. GROSHONG CATHETER ADVANTAGES - Answer-Clamping nor Heparin is needed. Only saline flush is needed. Irrigate every 7 days and after use. GROSHONG CATHETHER DISADVANTAGES - Answer-Surgery required Same maintenance as Hickman; however, Heparin not needed Complications are pneumothorax or sepsis HICKMAN/BROVIAC/GROSHONG CATHETERS ADVANTAGES - Answer-Has Dacron cuff to provide stability and minimize risk of infection due to bacterial migration. This lowers infection rate. Remains in place for months or years. Can be used intermittently. HICKMAN CATHETERS DISADVANTAGE - Answer-Cleanse site with peroxide Wipe catheter with alcohol Apply 2 by 2 gauze and change daily Do not remove exit site suture until ordered. IMPLANTED PORT TYPES - Answer-Port-a-cath, mediport, infuse-a-port IMPLANTED PORT ADVANTAGE - Answer-Cosmetic
Decreased vein damaged Less infection Flush once a month Flush one time a week for arterial if not accessed Weekly needle change when in use IMPLANTED PORT DISADVANTAGE - Answer-Special non-coring needle required Possibly pain upon access Consider avoiding use with needle phobia Topical anesthesia available. Requires surgical placement. IMPLANTED PORT SAFETY - Answer-Identify location and purpose prior to performing care and management. May place intraperitoneal, epidural, arterial, or venous. Only use non-coring needle, smallest gauge possible, insert perpendicular, clamp when open to air, flush before and after medications EPDURAL PORTS - Answer-Use preservative free medications. PORTS INFECTION PREVENTION - Answer-Maintain strict sterile technique during dressing, tubing, and cap changes Change dressing if loose, damp, or soiled and every 3 to 7 days per policy. Change caps with every dressing change, when blood is visible, when blood is withdrawn through cap, or leakage is present. PICC COMPLICATIONS - Answer-Infections, sepsis, air embolus, venous thrombosis
Flush with 10 ml syringe. Smaller than 10 ml syringe will result in too much pressure causing weakening or rupture of the PICC catheter. Elevate and minimize use of arm 24 hours post PICC placement. PICC CARE - Answer-KVO rate 10 ml/hr Clean all connections vigorously with alcohol. Claves or caps are changed every 7 days, with visible blood. No scissors should be used to remove dressing, or near PICC. In the event a PICC is inserted under emergency conditions; it should be evaluated and changed within 48 hours. TPA use to restore line patency should only be used by knowledgable nurse. Always wear gloves when working with PICCS. If allergic to Heparin, or platelet count is less than 100,000 discontinue Heparin flushes if using. Physician order required to use normal saline for flushes. DO NOT USE ANTIBIOTIC COATED CATHETERS - Answer-when patients are allergic to Sulfa
