Chapter 8: Techniques for Initiation and Maintenance of Central Vascular Access

Chapter 8: Techniques for Initiation and Maintenance of Central Vascular Access

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   A nurse is preparing to assist a physician with the insertion of a peripherally inserted central catheter (PICC). The physician intends to use a guidewire insertion technique to insert the catheter. Which is an adjunct to guidewire insertion technique for a PICC?

a.	Laser
b.	Breakaway needle
c.	Surgical cutdown
d.	Fluoroscopy

 

 

____     2.   A nurse aspires to be able to use and manage peripherally inserted central catheters (PICCs) in the home-care environment. For the nurse to safely and legally perform this function, the nurse must:

a.	hold a current license from the state.
b.	be trained in a state-approved agency and show proficiency in catheter insertion and maintenance.
c.	be a registered nurse (RN), meet minimal educational requirements, have employer-granted certification, and demonstrate evidence of competency.
d.	be an RN or licensed practical nurse and meet minimum state-approved educational requirements.

 

 

____     3.   A nurse using a pair of scissors to remove a dressing over a tunneled catheter cuts into the catheter. Which should the nurse use to repair the catheter?

a.	Any universal repair kit
b.	A blunt-end needle and an injection cap system
c.	The manufacturer’s repair kit
d.	None. The nurse should notify the physician, because nurses do not repair central venous catheters.

 

 

____     4.   A nurse specialist is preparing to insert a peripherally inserted central catheter (PICC).Which site is best for the insertion of the PICC?

a.	Basilic vein
b.	Innominate vein
c.	Subclavian vein
d.	Internal jugular vein

 

 

____     5.   A nurse specialist is preparing to insert a peripherally inserted central catheter (PICC). Complications related to the insertion of PICCs include:

a.	bleeding, malposition of the catheter, and nerve damage.
b.	phlebitis, infection, and SVC syndrome.
c.	thrombosis, pinch-off syndrome, and infection.
d.	septicemia, twiddler’s syndrome, and thrombosis.

 

Answer Section

 

MULTIPLE CHOICE

 

1. ANS:  B

The breakaway needle technique involves venipuncture made with an introducer needle. The catheter, with or without a guidewire, is threaded through the introducer. Fluoroscopy and surgical cutdown techniques are not used with PICC insertions.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

2. ANS:  C

The Infusion Nurses Society (INS) supports the standard that a licensed physician or licensed RN, as determined by state regulations, who is educated and has demonstrated competency can insert a PICC. The RN should complete an educational program for PICC insertion.

Reference: Infusion Nurses Society. (2011). Infusion standards of practice. Journal of Infusion Nursing, 34(1S), S11.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

3. ANS:  C

A sterile repair kit, specific to the type of catheter, should be readily available. Repairing the external portion of a tunneled catheter should be a sterile procedure that requires surgical gloves, a mask, and a cap.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

4. ANS:  A

The peripheral veins in the antecubital fossa are the usual sites for PICC access. The basilica vein is larger than the cephalic and passes upward in a smooth path along the inner side of the biceps muscle, terminating in the axillary vein.

 

PTS:   1                    KEY:  Cognitive Level: Application

 

5. ANS:  A

Bleeding, malposition, and nerve damage can occur during insertion. All other combinations of complications are postinsertion.

 

PTS:   1                    KEY:  Cognitive Level: Application