Patient Evaluation & Care Coordination Flashcards

A patient with a history of bilateral mastectomy requires IV access. What is the most appropriate initial action when selecting a vascular access site?

Answer: Consult with the physician regarding alternative access options given lymphedema risk bilaterally

Bilateral mastectomy creates bilateral lymphedema risk, making standard upper extremity access contraindicated without physician consultation and potentially requiring central venous access or lower extremity alternatives.

During the initial patient assessment for vascular access, which finding would most significantly influence the choice between a PICC and a tunneled central venous catheter?

Answer: Anticipated therapy duration exceeding 3 months with frequent blood draws

Therapy duration exceeding 3 months with frequent blood draws favors a tunneled CVC for its longevity, durability, and lower infection risk over extended periods compared to PICC lines.

A vascular access nurse is coordinating care for a patient transitioning from hospital to home IV therapy. Which action is the highest priority before discharge?

Answer: Confirming the home health agency can support the prescribed infusion therapy and device type

Confirming the home health agency's capability to manage the specific device and therapy prevents care gaps and ensures safe continuation of treatment after discharge.

Which assessment finding is a contraindication to placing a subclavian vein PICC?

Answer: Ipsilateral subclavian vein thrombosis

Ipsilateral subclavian vein thrombosis obstructs the pathway for PICC advancement and increases the risk of propagating the thrombus, making it a direct contraindication.

A nurse is evaluating a patient for vascular access and notes the patient's veins are difficult to visualize or palpate. What is the recommended next step according to current evidence-based guidelines?

Answer: Use ultrasound guidance to assess and cannulate peripheral veins

Current INS and AVA guidelines recommend ultrasound guidance for patients with difficult venous access to improve first-attempt success and reduce complications.

When performing a pre-insertion assessment for a PICC, a nurse measures the patient's arm circumference at 10 cm above the antecubital fossa. This measurement is primarily used for:

Answer: Establishing a baseline to monitor for deep vein thrombosis post-insertion

Baseline arm circumference measurement before PICC insertion allows post-insertion comparison to detect swelling indicative of DVT development.

A patient receiving chemotherapy via a PICC develops arm swelling and pain 10 days post-insertion. Which is the priority nursing intervention?

Answer: Discontinue infusion and notify the provider; assess for PICC-related DVT

Arm swelling and pain after PICC insertion are cardinal signs of PICC-related DVT; the priority is to stop the infusion, assess the patient, and notify the provider for diagnostic imaging.