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VA-BC Certification Study Material
Typology: Exams
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for dialysis catheters
increases
diopaque?: To facilitate location of catheter emboli in the event of shearing or fracture
6 days or less -Non-irritating medications and solutions
4 / 20 designed and labeled as a peripheral midline catheter
Maximun sterile barrer
device for midline placement will risk confusion related to the type of access device a patient has; places the catheter tip outside the SVC, which is contrary to the manufacturers' DFU related to the intention of the product and risks potential liability for the nurse.
atric patients?: Scalp veins Popliteal veins Saphenous veins
Emergency central vein access
may be excluded for patients with tracheostomies, radical neck dissection, and cervical fracture instability, or unstable airway Inability to position patient, insert or stabilize catheter
5 / 20 Avoid insertion on same side as a PICC that passes through the subclavian vein
external and/or internal B. Subclavian veins C. Femoral veins (least preferred)
(CABSI) what typed of PICC or non-tunneled catheters should be considered?- : Anti-microbial catheters
placement?: Maximun sterile
: slight Trendelenburg position
catheter placement?: to avoid the possibility of air emboli during the placement procedure
ed when accessing veins?: Blind-stick attempts.
confirmed?: ECG technology or radiograph
a PICC line?: A free flowing blood return
7 / 20 the upper arm
catheter tip locations in the upper SVC or midclavicular areas
Scalp veins, popliteal veins
parin (confirm infusatn compatibility)
continue for months or years
bloodstream infection -Severe coagulopathy -Cellulitis (attecting intended insertion site)
8 / 20 b. Jugular veins c. Femoral veins
thigh, or lower torso
the catheter?: A stabilizing Dacron cutt
to three weeks.
without a dressing?: Once the cutt has developed tissue attachment and the exit site is healed,
catheter tip location as the child grows?: To maintain internal tip in the SVC
for months to years
-Severe, uncontrolled sepsis -Burns or cellulitis (attecting the intended insertion site)
10 / 20 media for a computerized tomography (CT) or magnetic resonance imaging (MRI) scan
emergency situations
area of access -Bone disease
(away from the growth plate in the tibia)
fants and children
plasma or platelets
subclavian, or femoral vein
is generally 13 to 16 gauge
11 / 20 : Implanted ports, tunneled catheters, Dialysis/apheresis catheters.
atrium
draws and organ specific infusions
circulation via the ulnar artery determined by an Allen's Test prior to catheter insertion
femoral vein
cardiac function
stenosis Right heart mass Tricuspid or pulmonary mechanical valves
or internal jugular
insertion?: Pulmonary Artery catheters.
tration to remove excess fluid/sodium)
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In evaluating potential sites, what is an important but an often overlooked portion of the CVAD pre-procedural assessment?: Physical exam
Prominent superficial veins in the area of planned CVAD may indicate what?- : Neighboring or central vein stenosis or thrombosis
What should you assess upon physical exam when determining potential CVAD sites?: -Skin turgor with emphasis on skin condition at the planned insertion site -Presence of any skin lesions, scars, edema, ecchymosis, or grafts -Presence or absence of collateral veins -Swelling of the arm, chest, face or neck -Prominent superficial veins
Why should you avoid non-compressible or partially compressible target veins?: They denote probable thrombosis
What might variance in the vein diameter along the vein pathway do?: Variance in the vein diameter along the vein pathway which may interfere with catheter advancement
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When assessing to patient for potential CVAD sites why should you look at a recent CXR?: To check for pacemakers or Automatic Implantable Cardioverter Defibrillator (AICD), spinal rods or other implanted devices
What is an antiseptic?: A chemical agent that inhibits microorganisms on skin or tissue and has an ettect of limiting or optimally preventing infection.
What is a disinfectant?: A chemical agent that destroys microorganisms on inanimate objects
What is aseptic technique?: -A specific type of aseptic technique where key areas of items to be used for an infusion cannot be touched prior to insertion. -Once a site has been disinfected it can only be touched by the clinician if wearing sterile gloves. -All injection ports on I.V. tubing and end caps on catheter lumens MUST be properly disinfected prior to access
What are the properties of ideal skin antiseptic agents?: a. Broad spectrum of activity / rapid
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What are the recommended prep agents?: a. Chlorhexidine gluconate
How is Chlorhexidine gluconate applied?: In a back-and-forth motion for a minimum of 30 seconds
Against what type of organisms is Chlorhexidine gluconate effective?: gram positive and gram negative
With it's strong skin binding properties, what is the residual effect of Chlorhex-idine?: Up to 48 hours residual activity
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What is a pediatric consideration of Chlorhexidine?: USE WITH CAUTION FOR PREMATURE INFANTS AND CHILDREN < 2 MONTHS OF AGE
What are iodophors?: Solutions of iodine in complexes that contain a low amount of free iodine
What solutions contain up to l0% of an iodine complex, and provide up to 1% free iodine for skin antisepsis: Povidone iodine (e.g. Betadine™)
After the application of povidone iodine, what should NOT be applied?: Alcohol
What is effective against gram-positive and gram-negative bacteria, fungi, and viruses; but has minimal effect on bacterial spores?: Tincture of iodine
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What type and concentration of alcohol is still used extensively in skin antisep-sis?: Isopropyl Alcohol in a 70% concentration
How does alcohol exert antimicrobial effect?: By denaturing the cell proteins and dissolving the cell lipids
On what type of organisms does alcohol have an excellent or good effect?: Gram
What is the residual effect on the skin of alcohol?: Alcohol lacks residual antimicrobial property once the alcohol evaporates
Which antiseptic has a volatile or flammable nature until completely dry?: Al-cohol
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What effect can alcohol have on the skin?: Alcohol irritates and dries the skin
objects
surfaces and equipment
field and between patient use
