Access Devices Flashcards

Question 1

Q

Pinch off syndrome

Answer

A

Catheter compressed between first rib and clavicle, causing intermittent compression and pinching leading to intermittent occlusion of the infusion and aspiration

Increased risk of catheter fracture
Raise or lower the arm can usually relieve the occlusion and is hallmark sign of syndrome
Catheter must be removed and reinsert in a more lateral position to subclavian vein

Question 2

Q

Superior vena cava syndrome

Answer

A

SVCS is caused when the flow of blood in the SVC vein slows.

This vein carries blood from the head, neck, chest, and arms to the heart.
Blood flow may be slowed by a blood clot, a tumor, or because the vein is being compressed by nearby tissue
SVCS is most often seen in people with cancer. It’s most common with lung cancer or non-Hodgkin lymphoma

Question 3

Q

Superior vena cava syndrome symptoms

Answer

A

swelling of the face, neck, upper body, and arms
upper extremity swelling
distended neck veins
cough
dyspnea (difficult/labored breathing)
orthopnea (discomfort when breathing while lying down flat)
dysphagia
headache
dizzy/lightheaded
rapid breathing
coughing up blood

Swelling also seen in catheter migration - but is less extensive and just includes neck and/or chest

Question 4

Q

Catheter migration & symptoms

Answer

A

This occurs when the catheter has moved from where it was first placed

Signs of a migrated catheter include:

Increased length of the external catheter
Swelling in the neck or chest during an infusion
Pain or discomfort during the infusion
No blood return
Leaking at the catheter site.

Swelling also seen in superior vena cava syndrome - but is more extensive

Question 5

Q

Thrombotic catheter occlusions include:

Answer

A

Formation of thrombus within, surrounding, or at tip of catheter

intraluminal thrombus
fibrin sheath
fibrin tail
mural thrombus

Question 6

Q

Fibrin tail or flap

Answer

A

Extends from the catheter tip but is drawn inward, blocking the opening of the catheter lumen on aspiration attempts
Results in an ability to infuse fluids but an inability to withdraw blood

Question 7

Q

Intraluminal thrombus

Answer

A

Occurs when blood refluxes inside the catheter lumen
Common causes of reflux include coughing, inadequate flushing after blood draws or after checking for blood return, or improper use of flush syringes

Question 8

Q

Mural thrombus

Answer

A

Forms where the catheter touches or “rubs” the vein wall
Common sites are the entry site, anywhere along the catheter path, and the catheter tip

Question 9

Q

Fibrin sheath

Answer

A

Forms when fibrin adheres to the external catheter surface, which may include the entry site, and may encase all or part of the catheter like a sock
May completely cover the opening of the catheter tip

Question 10

Q

Management of thrombotic occlusions

Answer

A

Proper flushing AKA Pulsatile flushing technique

10 ml NaCl
push pause flushing method

Declotting solutions

tissue plasminogen activator

Question 11

Q

Inability to aspirate blood but still having ability to infuse through CVC suggests what type of occlusion?

A. Pinch off syndrome
B. Intraluminal thrombus
C. Calcium phosphate precipitate occlusion
D. Fibrin sheath/tail

Answer

A

Fibrin sheath/tail

Question 12

Q

How do intraluminal thrombus and calcium precipitate typically present?

Answer

A

Inability to infuse
Inability to aspirate

Question 13

Q

Nonthrombotic catheter occlusions include:

Answer

A

Precipitates
- Drug crystallization
- Drug-drug incompatibilities
- Drug-solution incompatibilities

Mechanical and malposition obstructions:
- Clamp on catheter
- Kinked catheter
- Tight retaining suture
- Pinch off syndrome
- Migration

Lipid residue
- Can accumulate in central venous catheters
- Often follows the administration of lipid-containing, TNA or drugs with oleaginous vehicles

Drug precipitates in the catheter may occur in conjunction with thrombus formation and should always be considered during assessment of an occlusion, since this may have implications for how the occlusion should be managed

Question 14

Q

How to manage precipitate occlusions

Answer

A

0.1 N hydrochloric acid
* Acidic precipitates (pH <6) like vancomycin, calcium-phosphate precipitates

70% ethyl alcohol or sodium hydroxide (0.1 mmol/mL)
* Lipid residue/precipitates

Sodium bicarbonate (1 mEq/mL)
* Alkaline drug precipitate (pH >7) like phenytoin or oxacillin

Lipids are soluble in alcohol

Question 15

Q

Temporary non-tunneled central catheter

Answer

A

Quick access device placed in emergencies or in ICUs
* Triple lumen subclavian, percutaneous, acute-care catheter, CVP
* Short term: 7-10 days
* Not for home use

Question 16

Q

Peripherally insterted central catheter (PICC)

Answer

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A

Inserted in peripheral vein (upper arm), with tip terminating in SVC/ right arterial junction
* Single, double, triple lumen
* Long term and widely used
* Not preferred for PN at home - need nurse for sterile dressing changes

Question 17

Q

Internal Jugular (IJ)

Answer

Study These Flashcards

A

Utilized in renal disease
* Allows preservation of peripheral and subclavian veins for AVF or grafts

Question 18

Q

Tunneled cuffed central catheters

Answer

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A

Surgically placed, for long term use

Question 19

Q

Implanted port

Answer

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A

Surgically placed in subcutaneous pocket anterior chest or arm
* Long term, minimal alteration in body image
* Lower infection and thrombosis rates
* Silicone catheter attached to plastic or titanium disk
* Access using ONLY non coring needle
* Can be accessed 1000-2000 x