Device Selection & Insertion Techniques Flashcards

A patient needs TPN with an osmolarity of 1,500 mOsm/L. Which access device is appropriate?

Answer: Central venous access device

Solutions exceeding 900 mOsm/L must be administered through a central venous access device to prevent peripheral vein damage.

Intraosseous (IO) access is most appropriate in which situation?

Answer: Emergency when IV access cannot be rapidly established

IO access provides rapid vascular access to the bone marrow cavity during emergencies when conventional IV access fails.

Which of the following is a contraindication to basilic vein PICC insertion?

Answer: History of DVT in the ipsilateral upper extremity

Previous DVT in the ipsilateral extremity contraindicates PICC insertion in that arm due to high risk of rethrombosis and vessel compromise.

What is the recommended maximum dwell time for a peripheral IV catheter in adults, absent complications?

Answer: 72–96 hours

CDC guidelines recommend rotating peripheral IV sites every 72–96 hours in adults unless clinical indication requires earlier removal.

During ultrasound-guided PICC insertion, the 'dynamic needle tip positioning' (DNTP) technique aims to:

Answer: Continuously visualize the needle tip throughout vessel entry

DNTP keeps the needle tip continuously in view on ultrasound during advancement, reducing risk of posterior wall puncture.

Which catheter stabilization method is preferred per INS guidelines to reduce CVAD-related complications?

Answer: Engineered stabilization device (ESD)

Engineered stabilization devices (ESDs) are preferred over sutures or tape as they reduce movement, dislodgement, and infection risk.

A nurse notices resistance when attempting to flush a PICC line. The FIRST action should be:

Answer: Assess for catheter kinking, positional changes, or clamp engagement

Resistance to flushing should first prompt assessment for mechanical causes (kinking, clamp, positional issues) before assuming occlusion.