Patient Evaluation & Care Coordination Flashcards

A multidisciplinary team is discussing vascular access for a patient admitted with septic shock who needs vasopressors, fluids, and blood draws simultaneously. Which device is most appropriate?

Answer: Multi-lumen central venous catheter

A multi-lumen CVC provides simultaneous administration of incompatible medications (vasopressors), fluids, and blood sampling without the limitations of peripheral or single-lumen access in critical illness.

A vascular access nurse is called to evaluate a patient who has had three failed peripheral IV attempts by floor nurses. On assessment, the nurse finds no suitable peripheral veins but the patient needs only a 3-day course of IV antibiotics. What is the most appropriate recommendation?

Answer: Attempt ultrasound-guided peripheral IV insertion before escalating to a PICC

For a short-term need, ultrasound-guided peripheral IV insertion should be attempted before escalating to a PICC, following the Infusion Nurses Society's vascular access device selection algorithm.

While reviewing a patient's chart before PICC insertion, the nurse notes the patient has an AV fistula in the left arm and a history of right-sided breast cancer with axillary lymph node dissection. Where should the PICC be placed?

Answer: Femoral approach, avoiding both arms

Both arms are contraindicated (left: AV fistula, right: lymph node dissection with lymphedema risk), so an alternative approach such as femoral or jugular access with provider collaboration is required.

A vascular access nurse completes a PICC insertion and obtains a post-insertion chest X-ray. The radiologist reports the tip is in the right atrium. What is the correct next action?

Answer: Withdraw the catheter by the estimated number of centimeters to reposition the tip at the cavoatrial junction

A tip in the right atrium must be withdrawn to the cavoatrial junction per standards, as right atrial placement increases the risk of arrhythmias and cardiac perforation.

In the context of vascular access care coordination, which action best demonstrates the nurse's role as a patient advocate?

Answer: Educating the patient about the risks and benefits of different access options and incorporating their preferences into the care plan

Patient advocacy in vascular access includes ensuring informed decision-making by educating patients about their options, risks, and benefits, and incorporating their preferences into the care plan.

A patient with an implanted port reports inability to aspirate blood or infuse fluids during a scheduled chemotherapy visit. After verifying needle placement in the port, what is the next appropriate assessment step?

Answer: Have the patient change positions (raise arms, cough, or turn their head) and retry aspiration

Positional changes can relieve tip malposition against the vessel wall (positional occlusion), and this simple maneuver should be attempted before escalating to thrombolytics or imaging.

A nurse performing a comprehensive vascular access assessment uses the mnemonic 'DIVA' (Difficult Intravenous Access). Which patient characteristic is included in validated DIVA scoring tools?

Answer: Vein visibility and palpability on tourniquet application

Validated DIVA assessment tools score vein visibility and palpability under tourniquet, along with history of difficult access and other anatomical factors, to predict IV insertion difficulty.