Patient Evaluation & Care Coordination Flashcards

A patient with stage 3 chronic kidney disease (CKD) requires IV antibiotics for 6 weeks. Which vascular access device best preserves future vascular access for potential dialysis?

Answer: Tunneled central venous catheter via internal jugular vein

In CKD patients, preserving arm veins for future AV fistula creation is critical; a tunneled CVC via the jugular vein avoids upper extremity vein damage while providing reliable long-term access.

During care coordination rounds, the team asks the vascular access nurse to recommend an access device for a patient requiring daily labs and intermittent IV medications for an expected 10-day hospitalization. The best recommendation is:

Answer: Peripheral IV catheter changed every 72-96 hours per policy

For a 10-day hospitalization with intermittent needs, a peripheral IV rotated per policy is the least invasive, most appropriate device; PICC lines are not indicated for short inpatient stays alone.

Which patient factor most increases the risk of catheter-related bloodstream infection (CRBSI) and should be identified during pre-insertion assessment?

Answer: Active immunosuppression or neutropenia

Immunosuppression and neutropenia impair the patient's ability to fight infection, significantly increasing CRBSI risk and necessitating enhanced prevention strategies.

A vascular access nurse receives an order for a PICC in a patient with a platelet count of 18,000/μL. What is the most appropriate action?

Answer: Contact the ordering provider to discuss thrombocytopenia and obtain platelet transfusion or alternative access plan

Severe thrombocytopenia (platelet count <50,000/μL) significantly increases bleeding risk with PICC insertion; the nurse should communicate this to the provider and collaborate on a safe insertion plan, which may include platelet transfusion.

When evaluating a patient for an implanted port, which physical assessment finding would be a contraindication to port placement in the chest?

Answer: Pacemaker or ICD leads on the ipsilateral side

Pacemaker or ICD leads on the same side as the planned port create a risk of lead displacement during subclavian/cephalic vein access and complicate port placement.

A home infusion patient calls reporting redness, warmth, and pain along the vein proximal to their midline catheter insertion site. The nurse should first:

Answer: Instruct the patient to stop the infusion and arrange immediate evaluation for superficial thrombophlebitis

Signs of superficial thrombophlebitis—redness, warmth, and pain along the vein tract—require immediate cessation of the infusion and prompt clinical evaluation for possible device removal.

Which element of a structured pre-insertion assessment directly informs the nurse's decision on catheter tip location?

Answer: Measurement of external arm length from insertion site to the sternal notch to right third intercostal space

Arm measurement from the insertion site to the sternal notch and then to the right third intercostal space estimates catheter length needed to achieve optimal tip position at the cavoatrial junction.