Maintenance and Care Flashcards

A hemodialysis catheter is to be used for blood draws. Which practice is recommended to minimize infection risk?

Answer: Use strict aseptic technique with mask, sterile gloves, and hub disinfection before each access

Hemodialysis catheters require maximum barrier precautions including mask and sterile gloves and thorough hub disinfection before every access due to high CRBSI risk.

Which finding is most consistent with catheter-associated thrombosis in a patient with an upper extremity PICC?

Answer: Unilateral arm swelling, pain, and erythema extending from the insertion site distally

Unilateral arm swelling, pain, and erythema extending from the PICC site are classic signs of upper extremity deep vein thrombosis associated with the catheter.

What is the recommended approach when instilling alteplase (tPA) to treat a completely occluded PICC?

Answer: Instill 2 mg/2 mL of alteplase, dwell for up to 120 minutes, then attempt aspiration

Instilling 2 mg/2 mL alteplase and allowing a dwell time of up to 120 minutes is the standard protocol for thrombolytic clearance of a completely occluded PICC.

A patient's PICC dressing is due for a change but the patient is in isolation for C. difficile. What PPE is required for the dressing change?

Answer: Contact precautions (gown and gloves) in addition to the standard maximal barrier precautions for the dressing change

Contact isolation precautions must be layered on top of standard dressing change technique, requiring a gown and gloves throughout the procedure.

Which type of IV administration tubing must be changed every 24 hours regardless of other factors?

Answer: Tubing used for lipid-containing parenteral nutrition or propofol infusions

Tubing used for lipid-containing solutions (TPN with fat emulsions) and propofol must be changed every 24 hours due to the risk of microbial growth in lipid media.

When performing a PICC dressing change, the nurse should assess the external catheter length and compare it to the documented baseline length. Why is this important?

Answer: To detect catheter migration, which can lead to malposition and complications

Comparing the external catheter length at each dressing change to the baseline detects migration, which can cause malposition, arrhythmias, or extravasation.

A tunneled Hickman catheter develops a crack in the external portion of the catheter. What is the most appropriate immediate action?

Answer: Clamp the catheter proximal to the crack, apply a sterile dressing, and notify the provider

Clamping proximal to a crack prevents blood loss and air embolism while a provider is notified to arrange catheter repair or replacement.