CRNI Central Venous Access Devices Practice Test Flashcards

What is the recommended flushing protocol for an implanted venous access port that is not actively being used?

Answer: Monthly flushing with heparinized saline

Implanted ports require monthly flushing with heparinized saline (typically 5 mL of 100 units/mL heparin) when not actively in use to maintain patency. The heparin lock prevents fibrin buildup and clot formation within the port reservoir and catheter lumen. Some newer ports may have different maintenance protocols per manufacturer guidelines.

Which assessment finding during a central venous catheter dressing change would indicate possible catheter migration?

Answer: The external catheter length has changed from the documented insertion measurement

A change in the external catheter length from the documented measurement at insertion is the primary indicator of catheter migration. If more catheter is visible externally, the tip may have withdrawn to a suboptimal position. If less is visible, the catheter may have advanced deeper. Either situation requires radiographic confirmation of tip position.

A nurse is unable to aspirate blood from a central venous catheter. What should be attempted first?

Answer: Reposition the patient — turn head, raise arm, have patient cough or perform Valsalva maneuver

Patient repositioning maneuvers should be attempted first when unable to aspirate blood from a CVC. The catheter tip may be resting against the vessel wall, and repositioning can shift it. Turning the head to the opposite side, raising the arm on the catheter side, deep breathing, coughing, or Valsalva maneuver may restore blood return without additional interventions.

What is the primary purpose of using an antimicrobial-impregnated central venous catheter?

Answer: To reduce catheter-related bloodstream infection through sustained antimicrobial activity

Antimicrobial-impregnated catheters (coated with chlorhexidine/silver sulfadiazine or minocycline/rifampin) reduce CRBSI by preventing bacterial colonization on the catheter surfaces. They are recommended for patients expected to have CVCs for more than 5 days in facilities with high CRBSI rates despite adherence to other prevention bundles.

Which central venous catheter insertion site has the lowest risk of catheter-related bloodstream infection?

Answer: Subclavian vein

The subclavian vein site has the lowest risk of catheter-related bloodstream infection in adult patients. The femoral site has the highest risk due to proximity to the groin and higher bacterial colonization. The internal jugular has an intermediate risk. Current guidelines recommend the subclavian site when feasible, balanced against the risk of pneumothorax.

A patient develops sudden dyspnea, tachycardia, and hypotension during central line removal. What is the most likely complication?

Answer: Venous air embolism

Venous air embolism is the most likely complication during central line removal, presenting with sudden dyspnea, tachycardia, and hypotension. Air enters through the tissue tract. Prevention includes positioning the patient in Trendelenburg, having the patient perform Valsalva during removal, and applying an occlusive dressing immediately after catheter withdrawal.