Download Vascular Access Certification Exam: Questions and Answers and more Exams Nursing in PDF only on Docsity!
VA-BC CERTIFICATION EXAM WITH COMPLETE
QUESTIONS AND CORRECT VERIFIED ANSWERS
(DETAILED ANSWERS) ALREADY GRADED A+ 100%
GUARANTEED TO PASS CONCEPTS!!!.
List indications for Vascular Access: - ANSWER-1. Total parenteral nutrition (TPN)
- Partial parenteral nutrition
- I.V. fluids and medications
- Blood and blood components
- Chemotherapeutic agents
- Cardiac monitoring
- Plasmapheresis
- Aquapherisis
- Hemodialysis a. Diagnostic testing b. Frequent blood sampling What is the French Scale? - ANSWER-Measurement of the outside size (diameter) of a catheter What is the range of Central venous catheter French sizes? - ANSWER-1.2fr for Neonates up to 15fr for dialysis catheters As the French size increases, what does the diameter of the catheter do? - ANSWER-It increases What is the gauge scale? - ANSWER-Measurement of the outside size(diameter) of a catheter As the gauge number gets larger, what happens to the catheter size? - ANSWER-It gets smaller. What is the gauge range of IV catheters? - ANSWER-24ga to 12 ga Why are all I.V. devices manufactured in the USA are required to be radiopaque? - ANSWER-To facilitate location of catheter emboli in the event of shearing or fracture
- Non-vesicant medications and solutions What are contraindications for a midline? - ANSWER--Arms with: A/V fistula, infection, fracture, trauma, or compromised circulation
- Chronic Kidney Disease What are the sites and vessel selection for midline catheters? - ANSWER-Basilic or cephalic vein in the antecubital fossa or lower part of the upper arm What product should be used for a midline placement? - ANSWER-A product that is specifically designed and labeled as a peripheral midline catheter What barrier precautions should be considered for midline placement? - ANSWER-Maximun sterile barrer Why should a PICC device NOT be used for midline placement? - ANSWER- Using a PICC device for midline placement will risk confusion related to the type of access device a patient has; places the catheter tip outside the SVC, which is contrary to the manufacturers' DFU related to the intention of the product and risks potential liability for the nurse. What is optimal tip location for a midline catheter? - ANSWER-One inch below the axillary area For midline placement, what alternative veins can be considered in pediatric patients? - ANSWER-Scalp veins Popliteal veins Saphenous veins
What are the indications for non-tunneled catheters? - ANSWER-Short term central vein access Emergency central vein access What are the contraindications for non-tunneled catheters? - ANSWER-Neck or chest sites may be excluded for patients with tracheostomies, radical neck dissection, and cervical fracture instability, or unstable airway Inability to position patient, insert or stabilize catheter Avoid insertion on same side as a PICC that passes through the subclavian vein What are the potential vessels for non-tunneled catheters? - ANSWER-A. Jugular veins, external and/or internal B. Subclavian veins C. Femoral veins (least preferred) In patients at greater risk for catheter associated bloodstream infections (CABSI) what typed of PICC or non-tunneled catheters should be considered? - ANSWER-Anti-microbial catheters What type of barrier precautions are required for non-tunneled catheter placement? - ANSWER-Maximun sterile How should a patient be positioned for non-tunneled catheter placement? - ANSWER-slight Trendelenburg position
- Infusion of irritating medications
- Infusion of vesicant agents What are the contraindications of PICC line placement? - ANSWER--Placement into an arm with fracture, trauma, infection, amputations, or compromised circulation
- Placement into an arm paralyzed as a result of a CVA may increase the risk of catheter-related thrombosis due to compromised circulation 4
- Chronic kidney disease patients What vessels are selected for PICC line placement? - ANSWER-Basilic, brachial or cephalic vein in the upper arm What barrier precautions are required for PICC placement? - ANSWER- Maximum sterile What areas of tip location should be avoided in PICC line placement? - ANSWER-Avoid catheter tip locations in the upper SVC or midclavicular areas What Alternative veins for PICC lines may be selected in pediatric pts.? - ANSWER-Scalp veins, popliteal veins In pediatric patients, what, if added ,may decrease catheter occlusion? - ANSWER-Heparin (confirm infusatn compatibility)
What are the indications for tunneled catheters? - ANSWER--Infusions that are projected to continue for months or years
- Apheresis What are the contraindications for tunneled catheter placement? - ANSWER-- Presence of a bloodstream infection
- Severe coagulopathy
- Cellulitis (affecting intended insertion site) which vessels are selected for tunneled catheters? - ANSWER-a. Subclavian veins b. Jugular veins c. Femoral veins Where might tunneled catheter exits sites be located? - ANSWER-The chest, upper back, top of thigh, or lower torso What attached to the catheter, will be positioned in the tissue track to secure the catheter? - ANSWER-A stabilizing Dacron cuff After a tunneled catheter placement, how long until the exit site heals? - ANSWER-Two to three weeks.
Femoral vein Name two things considered when placing an implanted port. - ANSWER-- Comfort related to the location of the implanted venous port
- Depth of the implanted port must be shallow enough for the clinician to palpate and insert a non-coring access needle safely to maintain access into the port septum Depending on the vein accessed, where might the port implantation site be located? - ANSWER-Port implantation site may be upper chest or lower abdominal side area How is the port secured inside the patient? - ANSWER-Port is sutured into a subcutaneous pocket under the skin Accessing an implanted port is always what type of procedure? - ANSWER- Sterile procedure What type of needle is used to access an implanted port? - ANSWER-Non- coring needle What are power-injectable catheters? - ANSWER-Power-injectable catheters are made of polyurethane and engineered to withstand high pressure > pounds per square inch (PSI) What are power injection catheters used for? - ANSWER-Used for power injection of I.V. contrast media for a computerized tomography (CT) or magnetic resonance imaging (MRI) scan
What are indications for an intraosseous device? - ANSWER-As an alternative to venous access in emergency situations What are contraindications for intraosseous placement? - ANSWER--Trauma or fracture in the area of access
- Bone disease What are possible selection sites for IO placement? - ANSWER-Sternum, iliac crest, femur or tibia (away from the growth plate in the tibia) What may be administered through an IO device? - ANSWER-I.V. fluids, blood and medications In emergency situations, in what population are IO devices often used? - ANSWER-Infants and children What are indications for dialysis or apheresis catheters? - ANSWER- Hemodialysis, apheresis for plasma or platelets What are possible vessels selected for dialysis/apheresis catheters? - ANSWER- Jugular, subclavian, or femoral vein Generally, what size are dialysis or apheresis catheters? - ANSWER-Catheter lumen size is generally 13 to 16 gauge Why are dialysis/apheresis catheters more rigid? - ANSWER-To facilitate rapid blood flow
In which type of catheter placement is cardiac monitoring used during insertion? - ANSWER-Pulmonary Artery catheters. What is the indication for an Aquapheresis catheter? - ANSWER-Diuretic resistant CHF (ultrafiltration to remove excess fluid/sodium) What is the contraindication for an aquapheresis catheter? - ANSWER-Lack of an accessible basilic vein in upper arm What vessel is selected for an aquapheresis catheter? - ANSWER-Basilic vein above the antecubital bend For what things are Aquapheresis catheters are not recommended? - ANSWER- Not recommended for infusions of fluids or medications What is the optimal tip location for an aquapheresis catheter? - ANSWER- 1 - 2 centimeters below the axilla What vessels are available to use with pediatric umbilical catheters? - ANSWER- 2 umbilical arteries 1 umbilical vein During what time frame may umbilical vessels be accessed? - ANSWER-Up to the 4th day of life. What are appropriate uses of an umbilical catheter located in a VEIN? - ANSWER--Blood sampling
What are appropriate uses of an umbilical catheter located in an ARTERY? - ANSWER--Blood sampling
- No TPN or vesicant infusions Site Determination: In evaluating potential sites, what is an important but an often overlooked portion of the CVAD pre-procedural assessment? - ANSWER-Physical exam Site Determination: Prominent superficial veins in the area of planned CVAD may indicate what? - ANSWER-Neighboring or central vein stenosis or thrombosis Site Determination: What should you assess upon physical exam when determining potential CVAD sites? - ANSWER--Skin turgor with emphasis on skin condition at the planned insertion site
- Presence of any skin lesions, scars, edema, ecchymosis, or grafts
- Presence or absence of collateral veins
- Swelling of the arm, chest, face or neck
- Prominent superficial veins Site Determination: Why should you avoid non-compressible or partially compressible target veins?
- ANSWER-They denote probable thrombosis Site Determination:
Skin Preparation: What are the properties of ideal skin antiseptic agents? - ANSWER-a. Broad spectrum of activity / rapid bactericidal activity b. Persistence or residual properties on the skin c. Maintain its activity in the presence of organic material d. Non-irritating or have low allergic and/or toxic responses e. No or minimal systemic absorption Site Preparation: What factors may affect the activity and effectiveness of an antiseptic solution?
- ANSWER-a. Organism's concentration in that specific area of the skin b. Organism's composition c. Concentration of the antimicrobial agent d. If it is combined with other antiseptic agents (e.g. as a tincture with alcohol) e. Duration of organism's exposure to the antimicrobial agent Site Preparation:
What are the recommended prep agents? - ANSWER-a. Chlorhexidine gluconate b. Iodophors c. Alcohol d. Surface disinfectant e. Adhesive remover f. Skin protectant Site Preparation: How is Chlorhexidine gluconate applied? - ANSWER-In a back-and-forth motion for a minimum of 30 seconds Site preparation: Against what type of organisms is Chlorhexidine gluconate effective? - ANSWER-gram positive and gram negative Site preparation: With it's strong skin binding properties, what is the residual effect of Chlorhexidine? - ANSWER-Up to 48 hours residual activity Site preparation:: What is a pediatric consideration of Chlorhexidine? - ANSWER-USE WITH CAUTION FOR PREMATURE
Site preparation: Once applied, how long is the residual effect of Iodophors? - ANSWER- Approximately two hours Which antiseptic has a volatile or flammable nature until completely dry? - ANSWER-Alcohol Site Preparation: What effect can alcohol have on the skin? - ANSWER-Alcohol irritates and dries the skin What is the purpose of a disinfectant wipe? - ANSWER-To kill bacteria, viruses, and fungi on inanimate objects Surface disinfectant are used on what type of surfaces? - ANSWER-Use on hard, nonporous surfaces and equipment In line placement, when are surface disinfectants used? - ANSWER-prior to setting up sterile field and between patient use What is the purpose of adhesive remover? - ANSWER-Removes sticky residue from tape or dressings Site preparation:
if iodine comes into contact with organic matter, such as blood, what happens?
- ANSWER-It is neutralized and no longer effective Site preparation: What solutions contain 1% to 2% iodine in an alcohol base? - ANSWER-Tincture of Iodine Site preparation: Why are iodophor solutions usually not used in neonatal and infant populations? - ANSWER-Percutaneous absorption of iodine has been noted in neonates, with hypothyroidism induction in newborns. Site preparation: After Povidone Iodine has dried, what can you do to minimize the effects of skin irritation and dryness? - ANSWER-Remove it with sterile saline wipes. Site preparation: What type and concentration of alcohol is still used extensively in skin antisepsis? - ANSWER-Isopropyl Alcohol in a 70% concentration Site preparation: How does alcohol exert antimicrobial effect? - ANSWER-By denaturing the cell proteins and dissolving the cell lipids
