Pediatric Access Flashcards

A child with a PICC line develops fever, chills, and hypotension 48 hours after insertion. The FIRST priority nursing action is:

Answer: Obtain blood cultures from the PICC and a peripheral site before antibiotics

Blood cultures should be drawn from both the PICC and a peripheral site before starting antibiotics to properly identify a catheter-related bloodstream infection (CRBSI).

Which pH range is considered SAFE for peripheral IV administration in pediatric patients to minimize risk of phlebitis?

Answer: 5.0–9.0

Solutions with a pH of 5.0–9.0 are considered safe for peripheral infusion, as extremes of pH cause chemical irritation and phlebitis of the vessel wall.

When using a transilluminator device to locate veins in a premature infant, the nurse should be aware of which RISK?

Answer: Thermal injury to fragile neonatal skin from prolonged light exposure

Prolonged transilluminator contact with fragile premature skin can cause thermal burns, so the device must be moved continuously and contact time minimized.

A 10-year-old child has a tunneled central venous catheter for long-term chemotherapy. The nurse notes the catheter has migrated 2 cm externally. The BEST action is:

Answer: Do not reposition; notify the provider and obtain a chest X-ray to verify tip position

A migrated catheter should never be advanced back in; the provider must be notified and tip position verified radiologically before resuming use.

In pediatric patients, which condition MOST increases the risk of catheter-associated thrombosis in a central venous catheter?

Answer: Congenital heart disease with polycythemia

Polycythemia in congenital heart disease increases blood viscosity, significantly raising the risk of thrombosis around central venous catheters.

Which dressing change interval is recommended by INS standards for a PICC site covered with a transparent semipermeable membrane (TSM) dressing in a pediatric patient?

Answer: Every 5–7 days or when soiled/lifting

INS standards recommend changing TSM dressings every 5–7 days or immediately when the dressing is soiled, wet, or no longer intact.

A nurse is preparing to insert a peripheral IV in a toddler who is extremely anxious. Which non-pharmacologic distraction technique is MOST evidence-based for this age group?

Answer: Using a buzzy device (vibration + cold) at the site during insertion

A Buzzy device combines cold and vibration using gate-control theory to reduce pain perception and is well-supported by evidence for toddlers during IV insertion.