OCC OCC Vascular Access & Infusion Techniques 2 — Questions and Answers
Question 1: A patient receiving a continuous 5-FU infusion via ambulatory pump reports that the pump alarmed and the site feels warm. What is the nurse's priority?
- Reset the pump alarm and reassess in 30 minutes
- Stop the infusion, assess for extravasation, and notify the provider (Correct answer)
- Increase the infusion rate to complete the dose on schedule
- Apply a warm compress and continue monitoring
Correct answer: Stop the infusion, assess for extravasation, and notify the provider
Warmth at the infusion site during chemotherapy administration suggests possible extravasation, requiring immediate cessation and assessment.
Question 2: Which intervention helps prevent fibrin sheath formation on a central venous catheter?
- Flushing with sterile water after each use
- Using tissue plasminogen activator (tPA) prophylactically after every infusion
- Flushing with 10 mL normal saline using a pulsatile push technique after each use (Correct answer)
- Filling the catheter lumen with ethanol between uses
Correct answer: Flushing with 10 mL normal saline using a pulsatile push technique after each use
Pulsatile flushing with normal saline creates turbulence that dislodges debris and prevents fibrin accumulation on catheter walls.
Question 3: The nurse suspects a PICC line has migrated based on the patient's complaint of gurgling sounds in the ear during infusion. What does this indicate?
- Normal catheter sounds during infusion
- Catheter tip has migrated into the jugular vein (Correct answer)
- Air in the infusion line
- The patient has developed atrial fibrillation
Correct answer: Catheter tip has migrated into the jugular vein
Gurgling or swishing sounds in the ear during PICC infusion indicate catheter tip migration into the jugular vein, requiring imaging confirmation and repositioning.
Question 4: Which dressing change frequency is recommended for a tunneled central venous catheter exit site according to current evidence-based guidelines?
- Every 24 hours with gauze dressing
- Every 7 days with transparent semi-permeable membrane dressing (unless soiled) (Correct answer)
- Every 48 hours with antimicrobial gauze
- Only when visibly soiled or loose
Correct answer: Every 7 days with transparent semi-permeable membrane dressing (unless soiled)
Current INS and CDC guidelines recommend transparent dressing changes every 7 days for tunneled CVC exit sites unless the dressing becomes wet, soiled, or loose.
Question 5: A patient with a new PICC line develops sudden onset of dyspnea, hypotension, and a 'sucking' sound during catheter manipulation. What complication is occurring?
- Pulmonary embolism
- Air embolism (Correct answer)
- Pneumothorax
- Catheter fracture
Correct answer: Air embolism
Air embolism can occur during open central catheter manipulation and presents with sudden dyspnea, hypotension, and a mill-wheel murmur or sucking sound.
Question 6: Which position should the nurse place a patient in if air embolism is suspected during central line removal?
- High Fowler's position
- Left lateral Trendelenburg (Durant's maneuver) (Correct answer)
- Supine with legs elevated
- Right lateral decubitus
Correct answer: Left lateral Trendelenburg (Durant's maneuver)
Left lateral Trendelenburg (Durant's maneuver) traps air in the right ventricle apex to prevent it from entering the pulmonary vasculature.
OCC OCC Vascular Access & Infusion Techniques 2
A patient receiving a continuous 5-FU infusion via ambulatory pump reports that the pump alarmed and the site feels warm.
What is the nurse's priority?