Comprehensive Nursing Pharmacology Q 21
Nurse Blessy is doing some patient education related to a patient’s central venous access device. Which of the following statements will the nurse make to the patient?
A. “These types of devices are essentially risk-free.”
B. “These devices seldom work for more than a week or two necessitating replacement.”
C. “The dressing should only be changed by your doctor.”
D. “Heparin is instilled into the lumen of the catheter to decrease the risk of clotting.”
Correct Answer: D. “Heparin is instilled into the lumen of the catheter to decrease the risk of clotting.”
A solution containing heparin is used to reduce catheter clotting and maintain patency. The concentration of heparin used depends on the patient’s age, comorbidities, and the frequency of catheter access/flushing. A common problem that complicates use of central venous access devices (CVADs) is occlusion by thrombosis. Alteplase, a recombinant tissue plasminogen activator, is used to restore line patency when thrombosis occurs. Heparin flush is commonly used to prevent this complication. heparin flush (10 units/mL) decreases thrombotic occlusions of CVADs, resulting in decreased alteplase use and fewer PICC line replacements.
Option A: Although patients have few complications, the device is not risk-free. Patients may develop an infection, catheter clots, vascular obstruction, pneumothorax, hemothorax, or mechanical problems (catheter breakage). A variety of complications are associated with central venous catheters, including those associated with catheter insertion and immediate access-related issues, as well as longer-term (>1 week) complications such as catheter malfunction, central vein stenosis or thrombosis, and catheter-related infection.
Option B: Strict adherence to protocol enhances the longevity of central access devices. They routinely last weeks to months and sometimes years. Ports are typically seen or felt on the chest wall or upper arm as a circular subcutaneous protuberance. They utilize the skin as a natural barrier to infection and patients can swim and bathe without issue. They have the lowest infection rates of all long-term central venous catheters, require little in the way of ongoing care, prolonged flush intervals (three to four weeks), and tend towards longevity. Each port membrane has a quoted survival of 1000–2000 punctures until it risks failure but this depends on needle size, operator skill, and other factors.
Option C: The patient will be taught how to perform dressing changes at home. The Centers for Disease Control recommends changing CVAD dressings in adult patients at least every 2 days for gauze dressings and at least every 7 days for transparent dressings.