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VA-BC Certification Study Exam Questions
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1.List indications for Vascular Access:: 1. Total parenteral nutrition (TPN) 2.Partial parenteral nutrition 3.I.V. fluids and medications 4.Blood and blood components 5.Chemotherapeutic agents 6.Cardiac monitoring 7.Plasmapheresis 8.Aquapherisis 9.Hemodialysis a. Diagnostic testing b.Frequent blood sampling 2.What is the French Scale?: Measurement of the outside size (diameter) of a catheter 3.What is the range of Central venous catheter French sizes?: 1.2fr for Neonates up to 15fr for dialysis catheters 4.As the French size increases, what does the diameter of the catheter do?: It increases 5.What is the gauge scale?: Measurement of the outside size(diameter) of a catheter 6.As the gauge number gets larger, what happens to the catheter size?: It gets smaller. 7.What is the gauge range of IV catheters?: 24ga to 12 ga 8.Why are all I.V. devices manufactured in the USA are required to be ra- diopaque?: To facilitate location of catheter emboli in the event of shearing or fracture 9.From what two materials are IV catheters made?: Silicone and
2 / 18 Polyurethane 10.Which catheter material can be affected by alcohol?: Polyurethane 11.What are the indications for short peripheral catheters?: -Infusions project- ed for 6 days or less -Non-irritating medications and solutions -Non-vesicant medications and solutions 12.What are contraindications for short peripheral catheters?: -Placement into an arm with fracture, trauma, infection, or compromised circulation -Veins in the arm on the same side of a mastectomy, breast surgery or lymph node dissection -Veins in the arm with an A/V fistula or graft 13.What veins are used for short peripheral catheters?: Metacarpal, cephalic, basilic and accessory veins of the arms 14.How many short peripheral catheter insertion attempts per healthcare provider are allowed?: 2
- What additional veins in pediatrics may be used for non-irritating/non-vesi- cant infusions?: Metacarpal, cephalic or basilic, scalp veins if <18mo 16.What are the indications for a midline catheter?: -Infusions projected for 6 days- 4 weeks -Non-irritating medications and solutions -Non-vesicant medications and solutions 17.What are contraindications for a midline?: -Arms with: A/V fistula, infection, fracture, trauma, or compromised circulation -Chronic Kidney Disease 18.What are the sites and vessel selection for midline catheters?: Basilic or cephalic vein in the antecubital fossa or lower part of the upper arm 19.What product should be used for a midline placement?: A product that is specifically designed and labeled as a peripheral midline catheter 20.What barrier precautions should be considered for midline placement?: - Maximum sterile barrer 21.Why should a PICC device NOT be used for midline placement?: 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. 22.What is optimal tip location for a midline catheter?: One inch below
4 / 18 Emergency central vein access 25.What are the contraindications for non-tunneled catheters?: 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 26.What are the potential vessels for non-tunneled catheters?: A. Jugular veins, external and/or internal B. Subclavian veins C. Femoral veins (least preferred) 27.In patients at greater risk for catheter associated bloodstream infections (CABSI) what typed of PICC or non-tunneled catheters should be considered?- : Anti-microbial catheters 28.What type of barrier precautions are required for non-tunneled catheter placement?: Maximum sterile 29.How should a patient be positioned for non-tunneled catheter placement?- : slight Trendelenburg position 30.Why is a patient placed in slight Trendelenburg position for non- tunneled catheter placement?: to avoid the possibility of air emboli during the placement procedure
- In non-tunneled catheter or PICC placement., what should always be avoid- ed when accessing veins?: Blind-stick attempts. 32.Prior to any infusion of non-tunneled catheters, how should tip location be confirmed?: ECG technology or radiograph 33.What must be obtained prior to ANY infusion of a non-tunneled catheter or a PICC line?: A free flowing blood return 34.What is the optimal tip location for a non-tunneled and PICC catheters?: - Cavoatrial juncture (CAJ) 35.If inserted through the femoral vein, what the optimal tip location for a non-tunneled and PICC catheters?: Inferior vena cava (IVC) above the level of the diaphragm 36.Why is the femoral vein is commonly used in pediatric critical care units for non-tunneled catheter placement?: Due to ease of insertion in young patients
5 / 18 37.Why may the jugular vein be the preferred point of insertion in very young children for non-tunneled catheters?: To avoid a pneumothorax
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8 / 18 48.Where might tunneled catheter exits sites be located?: The chest, upper back, top of thigh, or lower torso 49.What attached to the catheter, will be positioned in the tissue track to secure the catheter?: A stabilizing Dacron cuff
- After a tunneled catheter placement, how long until the exit site heals?: Two to three weeks. 51.When (upon physician approval) may a tunneled catheter be maintained without a dressing?: Once the cuff has developed tissue attachment and the exit site is healed, 52.In pediatric pts. with tunneled catheters, why do we assess/verify internal catheter tip location as the child grows?: To maintain internal tip in the SVC 53.What are the indications for an implanted port?: Infusions that are projected to continue for months to years 54.What are the contraindications for an implanted port?: -Severe coagulopa- thy -Severe, uncontrolled sepsis -Burns or cellulitis (affecting the intended insertion site) -Patient who is cachectic, below ideal body weight, or lacking subcutaneous tissue for port implantation 55.What vessels are selected for a "peripheral" implanted port?: Basilic or cephalic vein 56.What vessels are selected for a "central" implanted port?: Subclavian vein Jugular vein Femoral vein 57.Name two things considered when placing an implanted port.: - 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 58.Depending on the vein accessed, where might the port implantation site be located?: Port implantation site may be upper chest or lower abdominal side area
10 / 18 60.Accessing an implanted port is always what type of procedure?: Sterile procedure 61.What type of needle is used to access an implanted port?: Non- coring needle 62.What are power-injectable catheters?: Power-injectable catheters are made of polyurethane and engineered to withstand high pressure > pounds per square inch (PSI) 63.What are power injection catheters used for?: Used for power injection of I.V. contrast media for a computerized tomography (CT) or magnetic resonance imaging (MRI) scan 64.What are indications for an intraosseous device?: As an alternative to ve- nous access in emergency situations 65.What are contraindications for intraosseous placement?: -Trauma or frac- ture in the area of access -Bone disease 66.What are possible selection sites for IO placement?: Sternum, iliac crest, femur or tibia (away from the growth plate in the tibia) 67.What may be administered through an IO device?: I.V. fluids, blood and medications 68.In emergency situations, in what population are IO devices often used?: - Infants and children 69.What are indications for dialysis or apheresis catheters?: Hemodialysis, apheresis for plasma or platelets 70.What are possible vessels selected for dialysis/apheresis catheters?: - Jugular, subclavian, or femoral vein 71.Generally, what size are dialysis or apheresis catheters?: Catheter lumen size is generally 13 to 16 gauge 72.Why are dialysis/apheresis catheters more rigid?: To facilitate rapid blood flow 73.Which catheter insertions are surgical precures and required anesthesia?- : Implanted ports, tunneled catheters, Dialysis/apheresis catheters. 74.Where is the optimal tip location for a dialysis/apheresis catheter?: Upper right atrium 75.What are indications for an aerial catheter?: Monitoring arterial pressure, arterial blood draws and organ specific infusions 76.What are contraindications for radial artery catheters?: Lack of adequate arterial circulation via the ulnar artery determined by an Allen's Test prior to catheter insertion
11 / 18 77.What vessels are selected for placing arterial catheters?: Radial, brachial, axillary, or femoral vein 78.What is the indication for a Pulmonary artery catheter?: Assessment of cardiac function 79.What are contraindications for a PA catheter?: Mitral stenosis Right heart mass Tricuspid or pulmonary mechanical valves 80.What vessels are preferred for PA catheter placement?: The right subclavian or internal jugular 81.In which type of catheter placement is cardiac monitoring used during insertion?: Pulmonary Artery catheters. 82.What is the indication for an Aquapheresis catheter?: Diuretic resistant CHF (ultrafiltration to remove excess fluid/sodium) 83.What is the contraindication for an aquapheresis catheter?: Lack of an accessible basilic vein in upper arm 84.What vessel is selected for an aquapheresis catheter?: Basilic vein above the antecubital bend 85.For what things are Aquapheresis catheters are not recommended?: Not recommended for infusions of fluids or medications 86.What is the optimal tip location for an aquapheresis catheter?: 1 - cen- timeters below the axilla 87.What vessels are available to use with pediatric umbilical catheters?: 2 umbilical arteries 1 umbilical vein 88.During what time frame may umbilical vessels be accessed?: Up to the 4th day of life. 89.What are appropriate uses of an umbilical catheter located in a VEIN?: - -Blood sampling -All infusates 90.What are appropriate uses of an umbilical catheter located in an ARTERY?- : -Blood sampling -No TPN or vesicant infusions 91.Site Determination: In evaluating potential sites, what is an important but an often overlooked portion of the CVAD pre-procedural assessment?: Physical exam
13 / 18 -All injection ports on I.V. tubing and end caps on catheter lumens MUST be properly disinfected prior to access
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- Skin Preparation: What are the properties of ideal skin antiseptic agents?: 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 solu- tion?: 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?: a. Chlorhexidine gluconate b.Iodophors c. Alcohol d. Surface disinfectant e. Adhesive remover f. Skin protectant
- Site Preparation: How is Chlorhexidine gluconate applied?: In a back-and-forth motion for a mini- mum of 30 seconds
- Site preparation:
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- Site preparation: What solutions contain 1% to 2% iodine in an alcohol base?: Tincture of Iodine
- Site preparation: Why are iodophor solutions usually not used in neonatal and infant pop- ulations?: 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?: Remove it with sterile saline wipes.
- Site preparation: What type and concentration of alcohol is still used extensively in skin anti- sepsis?: Isopropyl Alcohol in a 70% concentration
- Site preparation: How does alcohol exert antimicrobial effect?: By denaturing the cell proteins and dissolving the cell lipids
- Site preparation: On what type of organisms does alcohol have an excellent or good effect?: - Gram + and Gram - bacteria fungus virus
- Site Preparation: What is the residual effect on the skin of alcohol?: Alcohol lacks residual antimicrobial property once the alcohol evaporates
- Site preparation: Which antiseptic has a volatile or flammable nature until completely dry?: Al- cohol
- Site Preparation: What effect can alcohol have on the skin?: Alcohol irritates and dries the skin
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- What is the purpose of a disinfectant wipe?: To kill bacteria, viruses, and fungi on inanimate objects
