Picu/Pcicu March Madness Bsi Quiz

1.

What components are required for drawing peripheral blood cultures? (You may choose more than one)

A.

Sterile gloves
B.

Mask for person drawing blood, assistant, and patient
C.

Hat
D.

CHG scrub (or alcohol swabstick/betadine swabstick if allergic to CHG)

Correct Answer(s)
A. Sterile gloves
B. Mask for person drawing blood, assistant, and patient
C. Hat
D. CHG scrub (or alcohol swabstick/betadine swabstick if allergic to CHG)

Explanation
Peripheral blood cultures in the PICU and PCICU require a CHG scrub, sterile gloves, and hat/mask for all participants. If you're wearing sterile gloves and a mask, always put on a hat!

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2.

True or False: If I draw morning labs off a patient's central line, I have to change the microclave end cap even if all the tubing was changed yesterday.

A.

True
B.

False

Correct Answer
B. False

Explanation
Caps must only be changed every 96 hrs with the tubing change or anytime they are removed from the line. Caps do not have to be changed with every or the first lab draw.The microclave end caps we use have zero dead space inside the cap and therefore, no room for blood/bacteria to accumulate. (exceptions for TPN, lipids, propofol, blood products)

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3.

Microclave end cap and tubing change dates should be documented:

A.

In Caredoc
B.

With a label on the tubing
C.

On the patient's task sheet

Correct Answer(s)
A. In Caredoc
B. With a label on the tubing

Explanation
The correct answer is to document the microclave end cap and tubing change dates in Caredoc and with a label on the tubing. This ensures that the information is recorded accurately in the patient's electronic medical record and that there is a visual reminder on the tubing itself. By documenting in Caredoc, healthcare providers can easily track and monitor the frequency of end cap and tubing changes, which is important for patient safety and infection control. The label on the tubing serves as a quick reference for healthcare providers to confirm when the last change was done.

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4.

True or False: An alcohol swabstick and a betadine (povidine-iodine) swabstick may be used for a dressing change if my patient is allergic to CHG.

A.

True
B.

False

Correct Answer
A. True

Explanation
An alcohol swabstick, followed by a betadine (povidine-iodine) swabstick, should be used for patients allergic to CHG. Clean with the alcohol first, then clean with the betadine swabstick in a circular motion, moving outward from the site.

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5.

True or False: Peripheral blood cultures may be drawn from my patient's arterial line if it was inserted within the previous 24 hrs.

A.

True
B.

False

Correct Answer
B. False

Explanation
Peripheral blood cultures can only be drawn from a patient's arterial line if it is done during the initial insertion while the sterile draping is still present.

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6.

True or False: T connectors on PIC/PICC lines should be changed with the tubing/cap change every 96hrs.

A.

True
B.

False

Correct Answer
B. False

Explanation
T connectors on PIC/PICC lines should be changed with the dressing change because they should be totally covered by the transparent dressing on the line.

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7.

My patient has a femoral arterial line. I need to wear a hat, mask and sterile gloves when: (You may choose more than one)

A.

Zeroing the line
B.

Drawing labs
C.

Changing the dressing
D.

Changing the NS Heparin bag daily
E.

Changing the tubing

Correct Answer(s)
A. Zeroing the line
B. Drawing labs
C. Changing the dressing
E. Changing the tubing

Explanation
Changing the NS Heparin bag daily only requires clean gloves. Everything else needs sterile gloves, hat, and mask!!

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8.

True or False: Sprinter ECMO cannula dressings have to be changed q24hrs.

A.

True
B.

False

Correct Answer
B. False

Explanation
Sprinter cannula dressings should have a Biopatch and transparent dressing and changed q7 days. Non-sprinter cannula dressings should be changed qshift and are gauze/tape.

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9.

My patient doesn't have an arterial line and is a really hard stick. The resident put in an order 2 days ago that nursing can draw off his Portacath for daily labs. Does this mean that I can draw off his central line to send labs?

A.

Yes
B.

No

Correct Answer
B. No

Explanation
An attending physician must put in an order to draw off a patient's central line and this order MUST be renewed every 24 hours. This ensures that the attending is aware of central line blood draws and the need for an arterial line will be evaluated frequently.

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10.

Who is responsible for ensuring a green line sheet is filled out for every central line insertion?

A.

The inserter
B.

The charge nurse
C.

The bedside nurse
D.

The insertion assistant

Correct Answer
C. The bedside nurse

Explanation
The bedside nurse is responsible for making sure a green line sheet is filled out for EVERY central line insertion. Other observers can fill out the sheet but the bedside nurse must ensure it has been done.

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11.

True or False: When changing the tubing and microclave end cap on my patient's Broviac, I need to scrub the connection of the old cap and lumen with alcohol for 15 seconds prior to removing the old cap, and then scrub the open lumen with alcohol before placing the new cap on the lumen.

A.

True
B.

False

Correct Answer
B. False

Explanation
Only the connection site between the old cap and lumen needs to be scrubbed prior to removing the old cap. The open lumen should NOT be scrubbed.

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12.

When accessing a port, I should: (You can choose more than one)

A.

Check for blood return prior to flushing with saline
B.

Flush with saline prior to drawing blood for cultures
C.

Flush the port with a little saline even if no blood return
D.

Spray the site with ethyl chloride prior to accessing
E.

Secure the Huber port needle with a steristrip prior to covering with a transparent dressing
F.

Draw 1ml waste when accessing the port
G.

Verify an order to access the port is in CPOE

Correct Answer(s)
A. Check for blood return prior to flushing with saline
C. Flush the port with a little saline even if no blood return
E. Secure the Huber port needle with a steristrip prior to covering with a transparent dressing
G. Verify an order to access the port is in CPOE

Explanation
Take care when flushing with saline if no blood return because line may be disconnected or fractured. A little saline flush may be required to obtain blood return. Lines should not be flushed prior to drawing blood for cultures because the inital blood sample contains the most bacteria. Ethyl chloride is not sterile and should not be used for sterile procedures. A single steri-strip can be used to secure Huber needle to prevent needle coming out and infiltrating into chest wall. 3ml of waste should be drawn to remove all the "sludge" from the port prior to infusing anything. An order is needed to access the port. If no blood return, notify provider. Must have an order to infuse anything through that line.

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13.

When hanging up a new bag of TPN, what do I need to change? (You can choose more than one)

A.

The tri-port connected to the lumen where I am hanging the new TPN
B.

The Precedex bag and tubing that is infusing in the same lumen as the TPN
C.

The microclave end cap on the lumen where I am hanging the new TPN bag
D.

The dressing on the line that was changed 2 days ago

Correct Answer(s)
A. The tri-port connected to the lumen where I am hanging the new TPN
B. The Precedex bag and tubing that is infusing in the same lumen as the TPN
C. The microclave end cap on the lumen where I am hanging the new TPN bag

Explanation
It is always best to have a dedicated line for TPN/IL when possible! When hanging new TPN/IL, you must change all the bags/drips/tubing/tri-ports connected to that lumen. Don't reattach a "dirty" line to a new TPN line!

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