Question

A client has a peripherally inserted central catheter (PICC) line in place for chemotherapy administration. Which nursing action will be performed first when administering the drug? ? A. Ensure patency by aspirating for a blood return ? B. Flush the line with normal saline ? C. Administer a low-dose heparin flush per protocol ? D. Infuse the chemotherapeutic agent

Short answer

Answer: Ensuring patency by aspirating for a blood return.

Step-by-step solution

Evaluate each option

Before determining the correct first action, we will evaluate each of the given options: 1. Ensuring patency by aspirating for a blood return: This action is essential to verify if the catheter is in the correct location and is functioning well. 2. Flushing the line with normal saline: Flushing is commonly used for cleaning the PICC line and preventing it from clot formation. 3. Administer a low-dose heparin flush per protocol: A low-dose heparin flush is used to prevent clot formation in the catheter, but it is always done according to the established protocol. 4. Infusing the chemotherapeutic agent: The administration of the drug is the final step after completing all the necessary precautions and actions.

Identify the first action

Among the given options, the first action to be performed before administering the chemotherapy medication is to ensure patency by aspirating for a blood return. This step verifies the correct positioning and functioning of the PICC line, ensuring the safe and effective administration of chemotherapy. Other options may follow, but the primary action must be ensuring patency. Hence, the correct answer is A.

Key concepts

Chemotherapy Administration

When it comes to administering chemotherapy via a peripherally inserted central catheter (PICC) line, nurses play a critical role in ensuring safety and efficacy of the treatment. The crucial first step is to ensure that the PICC line is patent, which involves aspirating for a blood return. This step confirms that the catheter is in the proper position within a central vein and that it is unobstructed, which is paramount for the delivery of chemotherapy agents.

After patency is confirmed, the nurse will typically proceed with the chemotherapy protocol, which includes flushing the line with normal saline to ensure it is clear of any residue or potential clots. Only after these preliminary safety checks are completed does the infusion of the chemotherapeutic agent begin. This meticulous approach minimizes the risk of complications such as a catheter occlusion or the infusion of medication into surrounding tissues, which could be harmful.

Ensure Patency

Ensuring patency of a PICC line is a fundamental nursing action that must precede most other procedures with the line. Patency implies that the PICC line is open and functioning correctly. A lack of blood return upon aspiration could indicate a possible occlusion or misplacement, prompting immediate attention.

To confirm patency, nurses aspirate for a blood return using a syringe, which should be easily drawn if the line is open. This simple yet crucial check is the safeguard against potential complications during medication administration, including chemotherapy. Regular patency checks are integral to PICC line management, and they are performed not only before administering medications but also as part of routine catheter maintenance.

Catheter Care

Proper catheter care is essential to maintain a PICC line and to prevent complications such as infections, thrombosis, and phlebitis. Nurses perform various procedures to uphold catheter integrity and function. One key aspect is to flush the line with normal saline or, where appropriate, a low-dose heparin solution, in accordance with hospital protocols. This routine flushing keeps the line clear of blockages and maintains its patency.

In addition to flushing, the catheter site requires regular inspection for signs of infection, including redness, swelling, or discharge. Ensuring a sterile technique during any catheter manipulation and dressing changes also constitutes proper catheter care, dramatically reducing risks associated with long-term catheter use.

• Maintaining an aseptic technique during all procedures
• Using appropriate dressings and securement devices to protect the insertion site
• Providing patient education on PICC line management and potential signs of complications

Together, these measures help ensure that the PICC line remains a safe and effective conduit for chemotherapy and other treatments that require central venous access.