CVAD Management

A nurse is caring for a patient with a central venous access device (CVAD). The patient reports hearing a gurgling sound in their ear during infusion, and the nurse notes increased external catheter length. What should be the nurse’s priority action?

• Flush the catheter with normal saline

• Prepare for fluoroscopy to confirm the catheter position 

• Apply a warm compress to the insertion site

• Administer prescribed antibiotics

Answer explanation

Hearing a gurgling sound in the ear during infusion and observing increased external catheter length are signs of possible catheter migration. The priority action is to confirm the catheter's position using fluoroscopy.

A nurse is assessing a patient with a central venous access device (CVAD) and notes redness, tenderness, and purulent drainage at the insertion site. What should be the nurse’s initial action?

• Apply a warm, moist compress to the site

• Take blood cultures

• Culture the drainage from the site

• Remove the catheter immediately

Answer explanation

The presence of redness, tenderness, and purulent drainage at the CVAD insertion site indicates a possible local infection. The nurse’s initial action should be to culture the drainage to identify the causative organism.

A patient with a CVAD presents with fever, chills, and malaise. What is the nurse’s priority action?

• Apply warm, moist compresses to the insertion site

• Take blood cultures

• Culture the drainage from the site

• Administer antipyretic therapy

Answer explanation

Fever, chills, and malaise in a patient with a CVAD suggest a systemic infection. The priority action is to take blood cultures to identify the causative organism and guide appropriate antibiotic therapy.

A nurse is unable to infuse fluids or aspirate blood from a patient's CVAD. What should the nurse do next?

• Assess and alleviate any clamping or kinking

• Force flush with a 10-mL syringe of normal saline

• Remove the catheter immediately

• Apply a warm compress to the insertion site

Answer explanation

When unable to infuse or aspirate, the nurse should first assess the catheter for any clamping or kinking and alleviate it if present. This is a common cause of catheter occlusion that can often be easily resolved.

A nurse suspects a pneumothorax in a patient with a central venous access device (CVAD). Which manifestation would the nurse expect to find?

• Bradycardia

• Increased breath sounds

• Distended unilateral chest

• Hypertension

Answer explanation

A pneumothorax in a patient with a CVAD typically presents with a distended unilateral chest due to air accumulating in the pleural space. Decreased or absent breath sounds, respiratory distress, and chest pain are also common manifestations. Bradycardia and hypertension are less likely to be associated with pneumothorax and CVAD complications.

A nurse is preparing to remove a peripherally inserted central catheter (PICC) from a patient. What action should the nurse instruct the patient to perform during the removal procedure?

• Take deep breaths

• Cough forcefully

• Perform the Valsalva maneuver

• Raise both arms above the head

Answer explanation

During the removal of a PICC, instructing the patient to perform the Valsalva maneuver helps to prevent air from entering the vein and assists in controlling bleeding at the insertion site. This maneuver increases intrathoracic pressure, which can help minimize the risk of air embolism and aid in hemostasis.

A nurse is removing a nontunneled central venous catheter (CVC) from a patient. After gently withdrawing the catheter, what is the nurse’s immediate priority action?

• Apply pressure to the site with sterile gauze

• Assess the catheter tip for intactness

• Administer antiseptic ointment to the site

• Document the procedure in the patient’s chart

Answer explanation

After gently withdrawing a nontunneled CVC, the nurse’s immediate priority is to apply pressure to the site with sterile gauze to prevent air from entering and to control any bleeding. This step is crucial in minimizing the risk of air embolism and ensuring hemostasis before further assessment of the catheter tip and application of antiseptic ointment.

A nurse is preparing to disinfect the injection port of a patient’s CVAD before medication administration. Which disinfectant solution should the nurse use?

• 70% alcohol

• Povidone-iodine

• Normal saline

• Chlorhexidine-based preparation

Answer explanation

Chlorhexidine-based preparations are preferred for disinfecting catheter hubs, needleless connectors, and injection ports due to their longer-lasting antimicrobial effects compared to alcohol or povidone-iodine. Proper disinfection helps prevent catheter-related infections by effectively killing bacteria on the surfaces accessed during medication administration or flushing.