The nurse working in an intensive care unit cares for a client with a left triple lumen subclavian central venous catheter (CVC). The nurse should call the primary health care provider (HCP) for clarification prior to implementation when recognizing that which prescription is an error?
A)Administer intravenous (IV) total parenteral nutrition (TPN) at 50 mL/hr
B)Change occlusive central line dressing every 7 days
C)Flush unused lumens of the CVC with 1000 units heparin every 12 hours
D)Use distal port of CVC to monitor central venous pressure (CVP)

Question

The nurse working in an intensive care unit cares for a client with a left triple lumen subclavian central venous catheter (CVC).  The nurse should call the primary health care provider (HCP) for clarification prior to implementation when recognizing that which prescription is an error?
A)Administer intravenous (IV) total parenteral nutrition (TPN) at 50 mL/hr
B)Change occlusive central line dressing every 7 days
C)Flush unused lumens of the CVC with 1000 units heparin every 12 hours
D)Use distal port of CVC to monitor central venous pressure (CVP)

Quizplus · Accepted Answer

11ecbb05_cb4a_2f9a_b433_ebcd7c16ea17_MD0009_00 Most CVC lumens require anticoagulation in the form of a heparin flush to maintain patency and prevent clotting when not in use. The nurse should check the institution's protocol and the HCP prescription to determine the correct dose. Doses of 2-3 mL containing 10 units/mL-100 units/mL are the standard of care for flushing a CVC. Doses of 1000-10,000 units are given for cases of venous thromboembolism; therefore, this prescription is an error and should be clarified by the nurse. The Centers for Disease Control and Prevention (CDC) recommend that a single-dose vial or prefilled syringe be used to reduce infection risk. Heparin is a high-alert medication (at high risk for causing significant harm to the client if given in error). (Option A) TPN should be administered through a CVC. Because of its viscosity and high glucose, lipids, electrolytes, vitamins and minerals, it is safest when administered through a CVC or peripherally inserted central catheter. (Option B) According to the CDC, an occlusive dressing should be changed every 7 days. The nurse should check the institution's protocol for frequency of dressing changes. (Option D) The distal port of a triple lumen CVC is the largest lumen (tube) and should be used for CVP (right atrium pressure) monitoring. The distal end of the CVC is in reverse as regards the client; therefore, the distal end is at the tip of the catheter in the superior vena cava vein, closest to the right atrium of the heart. Educational objective: Most CVCs require intravenous heparin flushes to maintain patency and prevent clotting. Single-dose vials of 2-3 mL of 10 units/mL or 100 units/mL are the standard of care. A dose of 1000-10,000 units is given for cases of thromboembolism.

The Nurse Working in an Intensive Care Unit Cares for a Client