1. Examples of nontunneled catheters: o 1. PICC lines (Peripherally Inserted Central
Catheter)- Discussed separately
o 2. Internal Jugular lines
o 3. Subclavian lines
o 4. Femoral lines
2. Non-tunneled catheters inserted by: Physician at bedside or surgical suite
3. How long is nontunneled catheter: 6-8 inches, skin is sutured at the site
4. How long are nontunneled catheters used for: Temporary emergency use, usually less than
a couple weeks
5. Insertion site and end placement of nontunneled catheter: Typically jugular (neck) or
subclavian (chest) into superior vena cava
6. Why is the femoral vein for nontunneled catheters used with caution: In- creased risk of
infection
7. Precautions when nontunneled catheter is inserted in an emergency situa- tion: -take out within
48 hours
-full PPE/barriers
8. Why is a chest radiograph done during nontunneled cath insertion: Verify proper tip placement
Prevent/ensure pneumothorax hasn't occurred
9. Disadvantage to nontunneled Cath: Easy dislodgement
-ensure proper secure ent with occlusive dressing
10.Tunneled catheters examples: - Groshong
- Hickman
- Hemodialysis catheters (Permcath / Vas Cath)
- Implanted Ports- Discussed separately
11.Insertion and exit site for tunneled catheters: Typically subclavian vein into superior vena
cava
12.The tunneled portion of the catheter contains a that tissue ad-
heres to after insertion.: Dacron cuff
13.Dacron cuff purpose: The cuff stabilizes the catheter and provides a barrier to organisms,
minimizing infection.
-No sutures at insertion site
-A bump can be felt an inch or two away from where the catheter comes out
14.Tunneled catheter may be necessary for what kind of patient: Patient requir- ing long-term
therapy
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May be permanent
15.The exit site is usually located on the and allows the patient easy access,
promoting self-care.: Chest
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16.When, where, and by who are tunneled catheters are inserted: Non surgical situations, in
operating room with radiology by a physician
17.Can nurses remove tunneled catheters?: NO!
18.Difference in appearance between tunneled and nontunneled catheter: -
Tunneled do not have wings for sutures
19.Dialysis precautions: o Dialysis catheters can only be accessed by a dialysis RN with an
order by the renal fellow or attending.
o Special training is required in handling dialysis catheters and proper flushing techniques.
o Dialysis catheters should only be removed by the physician
20.What is used to access an implanted port: Noncoring needle (Huber point needle) using
sterile technique
21.The use of standard needles can lead to what in an implanted port: Degra- dation and
embolization of port materials
22.Non-coding needles purpose/advantage: o have a different bevel angle allow- ing the septum
of the port to be punctured multiple times without damage.
23.how long is a PICC?: 14-20 inches
24.Where are PICCs inserted?: Antecubital fossa, basilic or cephalic vein
25.PICCs are typically inserted by who: RNs with help of US and X-ray prior to use
26.advantages of PICCs: cost effective, easy to place, good for moderate-long term therapy
27.when does a PICC need to be flushed: long cath, thin walls, flush before and after each use
and periodically when not in use
28.what volume to flush PICC lines: 10 ml syringe or larger
29.what is a max plus: needle-free IV connector that provides positive pressure
30.what should you clean a max plus with: alcohol
31.does max plus require clamping or heparinization: NO
32.What CVADs do not use Max plus: Groshong and implanted ports
33.Why should 10 ml syringe be used when flushing CVAD: small syringes create too much
PSI in catheter lumen
34.Guidelines when you should flush with 10ml syringe: after IV fluids after meds
Groshong and accessed implanted: q24hrs when not in use non-
tunneled and PICC: q8hrs for each port not in use
35.Guidelines for when you should flush with 20 ml NS: -blood admin
-getting blood
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