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Antecubital fossa

answer

area on the anterior surface of the arm situated in front of the cubitus, or elbow; anterior area where the arm bends when flexing at the elbow

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Asepsis

answer

methods used to assure that an environment is as pathogen-free as possible

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Basilic vein

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large superficial vein that arises from the ulnar side of the hand, passes up the forearm, and joins with the brachial veins to form the axillary vein

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Brachial veins

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veins following the course of the brachial artery and joining with the basilic vein to form the axillary vein

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Catheter

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a flexible tube passed into the body to remove or instill fluids or to keep a passageway open

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Catheter pinch-off

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rare complication of tunneled central venous catheters that occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion

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Central vascular access device

answer

umbrella term that includes a variety of catheters, cannulas, and infusion ports that allow intermittent or continuous central access to a blood vessel; a device usually inserted into the subclavian or jugular vein with the distal tip resting in the superior vena cava just above the right atrium and used for long-term intravenous therapy or parenteral nutrition

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Cephalic vein

answer

superficial vein that arises from the radial side of the hand and winds anteriorly to pass along the anterior border of the brachioradialis muscle, ascends along the lateral border of the biceps muscle and the pectoral border of the deltoid muscle, and finally opens into the axillary vein

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Chlorhexidine gluconate

answer

antibacterial compound with substantial residual activity that is used as a liquid antiseptic and disinfectant; trade name ChloraPrep®

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Colloid solution

answer

plasma expander; protein-containing fluid infused intravenously to help restore circulating blood volume

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Distal

answer

farthest from the origin of a part

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Dysrhythmia

answer

abnormal heart rhythm

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Embolus

answer

blood clot or bolus of air developed in or introduced into a blood vessel that moves from its place of origin and is capable of obstructing blood flow

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Extravasation

answer

see page or introduction of fluid, such as intravenous fluid, into the tissues surrounding a blood vessel; sometimes used interchangeably with infiltration but more accurately describes catheter dislodgement with medication infusing into the tissues and causing actual or potential tissue damage

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Fibrinolytic agent

answer

agent that dissolves fibrin, a protein that is essential for blood clotting, for the purpose of eliminating thrombi (blood clots); also called thrombolytic drugs

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Gauge

answer

standard of measurement used to quantify a lumen's size, with lower numbers reflecting larger catheters and vice versa

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Heparin

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parenteral anticoagulant

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Huber needle

answer

noncoring device used to access an implanted port

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Implanted port

answer

catheter whose end is attached to a small chamber placed in a subcutaneous pocket (instead of exiting from the skin), either on the anterior chest wall or on the forearm

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Implanted vascular access device

answer

any of a number of types of access devices that are surgically affixed underneath the skin

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Incompatibility

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lack of harmonious coexistence; used to refer to two or more medications or solutions that cannot be given simultaneously or mixed without changing the effects of each other or causing any new responses not seen with any of the drugs or solutions administered alone

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Infusion

answer

slow, intentional introduction of fluid into a vein

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Irrigate

answer

wash out with fluid

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Isopropyl alcohol

answer

transparent, volatile, colorless liquid used as a solvent and disinfectant and applied topically as an antiseptic

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Jugular vein

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large vein that returns blood to the heart from the head and neck, with two on each side of the neck (and external and an internal jugular vein)

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Lumen

answer

cavity or bore of a tubular organ or part

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Medial

answer

pertaining to or situated toward the midline

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Needleless

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referring to a device or system that can inject fluid without the use of a needle

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Negative pressure

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pressure (force) less than that of the atmosphere

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Non-thrombotic occlusion

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obstruction of a blood vessel by a means other than a blood clot

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Occlusion

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obstruction that impedes flow, such as a blood clot in a vein

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Patency

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state of being open or unobstructed

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Percutaneous

answer

performed through the skin

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Peripheral intravenous line

answer

system that allows fluids and medications to be delivered through a catheter inserted in a peripheral vein; colloquially called a peripheral IV

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Peripherally inserted central catheter (PICC)

answer

catheter used for long-term intravenous access and inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava

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Phlebitis

answer

inflammation of a vein

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Pinch off syndrome

answer

rare complication of tunneled central venous catheters that occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion

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Pneumothorax

answer

accumulation of air or gas in the pleural space

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Positive pressure injection cap

answer

cap attached to the end of a catheter that exerts positive pressure into the line after flushing and removing the syringe, thus preventing backflow of blood into the catheter and reducing the risk of occlusion

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pounds per square inch (psi)

answer

pressure a gas or liquid exerts on the walls of its container, measured in units of one pound of force or pressure applied to one square inch

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povidone-iodine

answer

topical anti-infective agent produced by reacting iodine with the polymer povidone to release iodine; trade name Betadine

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Precipitate

answer

deposit separated from a suspension or a solution and either falling to the bottom or floating on top

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Proximal

answer

nearest to the original of a part

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Reflux

answer

backward or return flow

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Reservoir

answer

portion of a central implanted device that provides a chamber implanted in a subcutaneous pocket with a catheter attached to the chamber and inserted into a central vein

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Right atrium

answer

upper chamber of the right side of the heart, which collects blood from the upper and lower venae cavae and transmits it to the right ventricle

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SASH (saline, administer, saline, heparin)

answer

technique for administering a medication intravenously, involving first flushing with normal saline solution, injecting the medication, flushing with normal saline, then flushing with heparin solution

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Sepsis

answer

presence in blood or other tissues of pathogens or their toxins

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Subclavian vein

answer

vein that continues the axillary vein as the main venous stem of the upper limb, follows the subclavian artery, and joins with the internal jugular vein to form the brachiocephalic vein

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Subcutaneous tissue

answer

layer of loose connective tissue directly under the skin

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Subcutaneous tunnel

answer

trench created surgically under the skin for an implanted central catheter

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Superior vena cava

answer

one of the two veins bringing deoxygenated blood from the upper body to the right atrium of the heart

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Tachycardia

answer

abnormally fast pulse rate, usually above 100 beats per minutes in an adult

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Thrombolytic agent

answer

agent that dissolves blood clots, for example, alteplase (Activase)

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Thrombotic occlusion

answer

deposits of fibrin and blood components, or clots, within and around the central line that interfere with flow

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Thrombus

answer

stationary blood clot within a blood vessel

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total parenteral nutrition (TPN)

answer

nutritionally adequate hypertonic solution containing glucose, electrolytes, and other nutrients delivered through an intravenous catheter

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transparent dressing

answer

protective covering often used over intravenous insertion sites to allow easy visualization of the site for signs of inflammation

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Trendelenburg position

answer

placement of a patient with the entire bed frame tilted with the head of the bed lowered

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tunneled technique

answer

creation of a trench surgically under the skin for an implanted central catheter

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turbulent flushing

answer

intermittent push-stop-push technique of quickly injecting a small amount of flush solution, pausing, then injecting again and repeating until all the flush solution has been injected

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Valsalva maneuver

answer

forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with the return of venous blood to the heart; performed with central line insertion to create a positive phase in central venous pressure, thus reducing the risk of air being drawn into the central circulation and creating an air embolus

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Vesicant

answer

chemical that produces blisters

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Viscous

answer

thick, sticky, or gummy; having a high degree of viscosity (resistance to flow)

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A nurse is preparing to flush a patient's peripherally inserted central catheter (PICC). Because the patient's catheter has a valved tip, the nurse

answer

uses non-heparinized saline solution for the flush. -Valve-tip or closed end valve catheters incorporate a valve that opens from positive or negative pressure generated by flushing or aspirating. Otherwise, the valve remains closed to keep blood from entering the catheter. Because blood does not back up into the catheter's lumen (where it could clot), catheters with these types of valves do not require heparinized flushes.

question

When flushing a central venous catheter (whether or not the catheter's tip is valved) what technique is recommended?

answer

a pulsatile (push - stop - push - stop) technique is recommended to create turbulence that helps clear any sediment from the line

question

What should the volume of a flush solution be?

answer

The volume of flush solution should be at least twice the volume capacity of the catheter and add-on devices, whether or not the catheter's tip is valved. Internal volumes vary with lumen size and type of catheter. On average, a PICC holds up to 1 mL, but the volume of the extension tubing and connectors must also be considered. Generally, a volume of at least 5 mL is appropriate for most routine flushes.

question

An older adult patient who adheres to a regular cardiovascular rehabilitation schedule that includes water aerobics and swimming requires long-term central venous access. Which of the following central venous access devices is the best choice for allowing him to continue his aquatic program?

answer

An implanted port -Because the entire device lies beneath the skin, the patient can be immersed in water when the device is not in use without any increased risk of infection. This is the best choice for patients who wish to continue aquatic activities.

question

A nurse is caring for a patient who has a central venous access device in place. Which of the following routine measures should the nurse use specifically to prevent lumen occlusion?

answer

Clamping the extension tubing while removing a syringe from the injection cap -This is an example of a positive-pressure technique designed for use when a central venous access device does not have a specialized positive fluid-displacement needleless connector. This type of technique prevents the reflux of blood back into the catheter, which can clot and obstruct the catheter.

question

A patient who sustained trauma from a motor-vehicle crash is transported to an emergency department. The provider determines the need for immediate central venous access for fluid and blood replacement and prophylactic antibiotic therapy. The appropriate central venous access device for this patient is

answer

a nontunneled percutaneous central catheter. -This type of central catheter is ideal for emergency situations where short-term (less than 6 weeks) central venous access is required for multiple therapies. This is the appropriate choice for this patient.

question

A nurse is caring for a patient who has a central venous catheter and suddenly develops dyspnea, tachycardia, and dizziness. The nurse suspects air embolism and clamps the catheter immediately. The nurse should reposition the patient in which of the following positions?

answer

On his left side in Trendelenburg position -This position helps trap the air in the apex of the right atrium rather than allowing it to enter the right ventricle and, from there, move to the pulmonary arterial system.

question

A nurse is caring for a patient who has a central venous catheter. When flushing the catheter, the nurse uses a 10-mL syringe to prevent which of the following complications associated with central vascular access devices?

answer

Catheter rupture -When injecting fluid through a catheter, a smaller syringe generates more pressure than a larger syringe does. Therefore, to reduce the risk of catheter rupture, syringes that are 10-mL or larger in size are recommended for flushing or injecting fluid into a central venous catheter.

question

A nurse caring for a patient who has gastric cancer is initiating an infusion of parenteral nutrition via the patient's implanted port. Which of the following is an appropriate action for the nurse to take?

answer

Cover the device and the needle with a sterile transparent dressing. -When an implanted port remains accessed for an infusion, the needle must first be supported and anchored, then the port and the needle are covered with a transparent dressing.

question

A nurse is preparing to obtain a blood sample from a patient who has a triple-lumen central catheter in place for multiple therapies. Which of the following is an appropriate action for the nurse to take?

answer

Turn off the distal infusions for 1 to 5 minutes before obtaining the blood sample. -To help ensure that the laboratory results won't be altered by the solutions infusing through the central access device, it is recommended that the nurse stop the distal infusions and clamp the tubing for 1 to 5 minutes before obtaining the blood sample. How long to stop the infusion varies with the type of infusion.

ATI Central Venous Access Devices – Flashcards

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