Clinical Procedures & Techniques Flashcards

A CVAD flushes easily, but no blood return can be drawn. What is the most likely cause?

Answer: Persistent withdrawal occlusion from a fibrin tail or sheath

A fibrin tail or sheath acts like a one-way valve, so fluid can go in but blood cannot be drawn out.

An adult CVAD has a thrombotic occlusion. What is the standard alteplase dose for clearing it?

Answer: 2 mg in 2 mL instilled into the lumen, with a dwell of up to 2 hours

For patients 30 kg and over, 2 mg/2 mL alteplase is instilled and left to dwell 30 to 120 minutes, and it can be repeated once.

A subclavian catheter occludes only when the patient's arm is at their side and works when the arm is raised. Which complication should you suspect?

Answer: Pinch-off syndrome

Pinch-off syndrome is compression of the catheter between the clavicle and first rib, and it can lead to catheter fracture and embolization.

A patient becomes suddenly short of breath and hypotensive during a CVAD tubing change, and an air embolism is suspected. What position should you use right away?

Answer: Left lateral decubitus with Trendelenburg

Left side-lying with the head down (Durant's maneuver) traps the air in the right atrium, away from the pulmonary outflow tract, and 100% oxygen is given.

Why must an implanted port be accessed only with a non-coring (Huber) needle?

Answer: Its deflected tip does not cut a core out of the silicone septum

Non-coring needles keep the septum intact, preventing leaks and septum fragments from entering the reservoir.

After an anthracycline such as doxorubicin extravasates, which systemic antidote is recommended?

Answer: Dexrazoxane

IV dexrazoxane is the antidote for anthracycline extravasation, with cold compresses and no local heat.

After a right-arm PICC insertion, the patient reports a gurgling sound in the right ear during flushing. What malposition does this suggest?

Answer: The tip has gone up into the internal jugular vein

Hearing fluid or gurgling in the ear, or feeling neck discomfort, during a flush suggests the tip is in the internal jugular vein.