Insertion Techniques & Complications Management Flashcards

A patient with a totally implanted venous port requires access for the first time since surgical placement 6 weeks ago. The nurse cannot palpate the port septum clearly. Which action is MOST appropriate?

Answer: Use ultrasound guidance to locate the port septum before accessing

Ultrasound guidance is recommended when the port cannot be clearly palpated, reducing the risk of coring the port body or missing the septum.

When using a non-coring Huber needle to access a port, the needle bevel should be oriented in which direction?

Answer: Bevel facing upward (toward the ceiling)

Huber needles have a deflected tip; the bevel is oriented upward so the needle enters the septum and deflects laterally rather than coring out a plug of silicone.

A patient develops pain, swelling, and erythema over their implanted port site 3 days after access. A pocket infection is suspected. Which assessment finding would most strongly support the need for port explantation rather than antibiotic salvage?

Answer: Fluctuance and skin breakdown over the port pocket

Fluctuance and skin breakdown indicate abscess formation in the port pocket, which typically cannot be managed with antibiotics alone and requires surgical removal.

Which catheter characteristic is MOST associated with increased risk of catheter-associated thrombosis?

Answer: Silicone material with multiple lumens

Silicone catheters and larger catheter-to-vein ratios (occupying more of the vein lumen) are associated with higher thrombosis risk due to material properties and impaired venous flow.

A bedside nurse notes that a PICC dressing has become wet and is lifting at the edges after a patient's bath. The insertion site appears clean without signs of infection. What is the correct action?

Answer: Remove and replace the dressing using aseptic technique immediately

A wet, loose, or compromised dressing must be changed immediately using aseptic technique to maintain the sterile barrier and prevent CRBSI.

During subclavian central line insertion, the clinician notes bright red, pulsatile blood entering the syringe. What is the MOST appropriate immediate action?

Answer: Withdraw the needle and apply firm direct pressure for at least 10 minutes

Inadvertent subclavian artery puncture requires immediate needle withdrawal and sustained direct pressure, though accessing the subclavian artery makes pressure application difficult compared to more compressible sites.

A patient with a PICC presents with neck swelling, arm edema, and difficulty swallowing 2 weeks post-insertion. Imaging confirms superior vena cava syndrome. Which factor is MOST likely to have contributed to this complication?

Answer: Prior history of multiple central venous catheterizations causing venous stenosis

Repeated central venous catheterizations cause intimal injury and scarring that can lead to venous stenosis or thrombosis, predisposing patients to SVC syndrome.