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Troubleshooting Central Vascular Access Devices (CVADs)
by Donna Elmore, BSN, MS, RN-BC, CCRN, CMSRN, CNRN
CE138-60 | 1.00 contact hrs

Please review the required clinical vignette below and answer the quiz questions.
You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

Once you successfully completed the short test associated with the clinical vignette, proceed to the multiple-choice exam.
To earn contact hours, you must achieve a score of 75% on your exam. You may retake the test as many times as necessary to pass the test.

A 35-year-old woman was diagnosed with cancer of the right breast, which required a mastectomy. An implanted port was placed on the left chest wall. X-ray verified catheter tip placement in the brachiocephalic vein. The nurse accessed the port and documented that no blood return was obtained. However, believing the port was patent, even though she did not obtain blood return, the nurse infused ondansetron (Zofran), followed by an injection of 60 cc of doxorubicin (Adriamycin). After the nurse injected the doxorubicin, she once again documented the absence of blood return. As the drug was being injected, the patient complained of pain in the lower chest area below the ribs. Realizing this is not a normal reaction, the nurse discontinued the injection of the chemotherapeutic agent. The patient again complained of severe chest pain with a burning sensation in her lower chest area. The nurse notified the physician of the change in the patient’s condition. A chest X-ray and cathetergram were ordered. The test results showed the catheter tip had punctured the vein wall, and the medication was injected into the left chest cavity, resulting in permanent scarring of the left lobes of the lung. Although the patient’s cancer was cured, she was left with a permanent lung deficit.

1 ) The most appropriate location for all CVAD catheter tips, for all therapies, is:

2 ) Severe chest pain during the infusion of IV medications through a CVAD is:

3 ) When a clinician notes an absence of blood return, this is most likely because of:

4 ) What is the appropriate clinical intervention when no blood return is obtained on a CVAD?