VA BC Certification Study Guide with Questions and 100% Correct Answers, Exams of Nursing

Download VA BC Certification Study Guide with Questions and 100% Correct Answers and more Exams Nursing in PDF only on Docsity! VA BC Certification Study Guide with Questions and 100% Correct Answers from Actual Questions Updated 2023-2024 Best Studying Material What are the Indications and contraindications for a Implanted venous port? --------- Correct Answer --------- infusions for months to years. Severe coagulopathy, uncontrolled sepsis, burns, cellulitis on site, cachectic, below body weight or lacking tissue for port implantation. What are the Contraindications for a PICC? --------- Correct Answer --------- Placement in arm with fracture, trauma, infection, amputation, paralyzed (thrombosis risk), compromised circulation. Chronic kidney disease patients. What is the vessel selection for a PICC? --------- Correct Answer --------- Basilic, brachial, cephalic vein. What are the insertion procedures for a PICC? --------- Correct Answer --------- Antimicrobial catheters for high risk patients, follow guidelines, Max sterile barrier precautions, Avoid blind stick, avoid catheter tip in upper SVC or midclavicular, Confirm with ECG or radiograph, check for blood return prior to infusion What are the supplies for a PICC and what is the Optimal tip location? --------- Correct Answer --------- PICC device, Sterile insertion tray, Ultrasound, ECG system, normal saline flush, heparin flush. Caval atrial juncture What are the Pediatric considerations for a PICC? --------- Correct Answer --------- Alternative vein selection like scalp and popliteal vein. Heparin may decrease catheter occlusion. What are the indications for a Tunneled Catheters? --------- Correct Answer --------- Infusions for months or years, Apheresis, What are the contraindications for a Tunneled Catheters? --------- Correct Answer -------- - Current infection, severe coagulopathy, Cellulitis on insertion site. What are the vessel selection for a tunneled catheter? --------- Correct Answer --------- Subclavian, Jugular, and Femoral vein. What is the insertion procedure for tunneled catheter? --------- Correct Answer --------- Follow guidelines, sedation, stabilizing dacron cuff attached to the catheter will be positioned in the tissue track to secure the catheter, exit site will heal within 2-3 weeks, once cuff has developed tissue attachment and exit site is healed, it may be maintained without a dressing upon physician approval, confirm with ECG or Xray, obtain free flowing blood. What are the supplies for a tunneled catheter? --------- Correct Answer --------- tunneeled central venous catheter, sterile insertion tray, ultrasound, surgical equipment, dressing supplies, normal saline, heparin flushes, What is optimal tip location and pediatric considerations for tunneled catheter? --------- Correct Answer --------- Cavoatrial junction or Inferior vena cava. Catheter tip location (assess as the child grows to maintain in SVC. What is a pediatric consideration of Chlorhexidine? -------- Correct Answer -------- USE WITH CAUTION FOR PREMATURE INFANTS AND CHILDREN < 2 MONTHS OF AGE Site preparation: What are iodophors? -------- Correct Answer -------- Solutions of iodine in complexes that contain a low amount of free iodine Site preparation: What solutions contain up to l0% of an iodine complex, and provide up to 1% free iodine for skin antisepsis -------- Correct Answer -------- Povidone iodine (e.g. Betadine™) Site preparation: After the application of povidone iodine, what should NOT be applied? -------- Correct Answer -------- Alcohol Site preparation: What is effective against gram-positive and gram-negative bacteria, fungi, and viruses; but has minimal effect on bacterial spores? -------- Correct Answer -------- Tincture of iodine Site preparation: For an antiseptic effect to occur with Iodophors, what must happen? -------- Correct Answer -------- The antiseptic must have contact with the skin for two minutes or more to release free iodine Site preparation: Once applied, how long is the residual effect of Iodophors? -------- Correct Answer ------- - Approximately two hours What is the optimal tip location for implanted venous port? --------- Correct Answer ------- -- Cavoatrial junction, inferior vena cava above level of diaphragm if inserted into femoral vein. What are the Indications and contraindications for Intraosseous Devices? --------- Correct Answer --------- Indications are to use it as a alternative to venous access in emergency situations. Used often in Peds. Contraindications is trauma, fracture, or bone disease in access area. What is the insertion procedures and supplies for the Intraosseous Devices? --------- Correct Answer --------- Follow manufactures directions, site disinfection, aseptic technique, IV fluids, blood and meds may be administered. Supplies are interosseous access needle device, disinfecting agent, numbing agent, transparent dressing. What are the indications and contraindications for dialysis or apheresis Catheters? ------ --- Correct Answer --------- Indications are hemodialysis, apheresis for plasma or platelets. Contraindications is that its rarely used for infusion What is the site and vessel selection for Dialysis or Apheresis Catheters? --------- Correct Answer --------- Jugular, Subclavian or femoral vein. What is the Insertion procedures and Supplies for Dialysis or Apheresis Catheters? ------ --- Correct Answer --------- Follow manufactures directions, may be scheduled as operative procedure or interventional radiology procedure, catheter lumen is 13-16 gauge size, catheter ridged for rapid blood flow, avoid blind stink. Supplies are Dialysis or Apheresis catheter device, sterile insertion tray, ultrasound equipment, surgical equipment. What is the Optimal Tip Location for Dialysis or Apheresis Catheters? --------- Correct Answer --------- Upper right atrium What are the indications and contraindications for pulmonary artery catheters? --------- Correct Answer --------- Indications is assessment of cardiac function specifically to monitor Cardiac output. Contraindications is mitral stenosis, right heart mass, tricuspid or pulmonary mechanical valves. What is the site for pulmonary artery catheters? --------- Correct Answer --------- right subclavian or IJ What are the indication and contraindications for Aquapheresis Catheters? --------- Correct Answer --------- Indications is diuretic resistant CHF and contraindications is lack of accessible basilic vein in upper arm. What is the Optimal tip location for Aquapheresis Catheters? --------- Correct Answer ---- ----- 1-2 centimeters below the axilla Describe the things you need to know about Pediatric Umbilical catheters? --------- Correct Answer --------- The available vessels include 2 umbilical arteries and 1 umbilical vein. may access up to the 4th day and can use up until the 14th day. What size needle do you need for blood? How do you know if you cannulated an artery? You have a 16 year old patient and the PICC appears to be on the left side, how do you determine its in the vein and not artery? --------- Correct Answer --------- 20-24 Bright red blood Preform ABG Patient needs one dose of vanco what would you recommend? How do you determine IO position placement? --------- Correct Answer --------- Midline across abdomen If patient states NO IV what do you? What body position do you do for PICC removal? What arm position for PICC removal? When should dressing be changed? --------- Correct Answer --------- Recommend IV upward arm below 2 days with gauze, 7 days without gauze The left SVC dumps into what? When should the arterial line set up be changed? How often do you change arterial lines? --------- Correct Answer --------- coronary sinus 96 hrs as needed Best way to keep the pulmonary artery catheter free of infection? How often do you change IV setups? What does the Swan (Pulmonary artery catheter) measures? --------- Correct Answer ---- ----- put in sleeve 96 Hrs CO (cardiac output) CDC guideline for max barrier include what? Should you cut a PICC with a distal valve? What is optimal placement for a MIDLINE? --------- Correct Answer --------- Sterile gloves, cap, gown, full body sterile drape. NO 1 inch below axilla Which line has the less incidence of infection? What values are considered for chronic kidney? What should you use for a HD cath? --------- Correct Answer --------- PORT GFR under 60 and creatinine above 2 Large bore double lumen How long should you flush for? How long can the umbilical cord be used? Why is vein selection harder in babies? --------- Correct Answer --------- 2 times the length of catheter 14 days less options Which part of the vessel has the most smooth muscle? Abian family wants everything done even though patients outcome is death what do you do? --------- Correct Answer --------- media respect there cultural beliefs on death. What should you consider for Device Selection in adults? What are the pediatric considerations? --------- Correct Answer --------- Patient assessment like: preference, lifestyle, willingness to preform maintenance, history, complications, review of variables to determine correct VAD, high risk factors, advantages and disadvantages. limited selection, fewer veins, VAD's preserve vessels, caregiver education, avoid scalp vad's in infants rolling, avoid lower extremity Vad's for crawling patients. What are the Indications for short peripheral catheters? --------- Correct Answer --------- infusion for 6 days or less. non-irritating and non-vesicant medications and solutions. What are the contraindications for short peripheral catheters? --------- Correct Answer --- ------ Placement into arm with fracture,trauma, infection, or compromised circulation. Veins in the arm on the side of a mastectomy, breast surgery, lymph node dissection, av fistula or graft. What are the preferred vessels for Short peripheral catheters? --------- Correct Answer -- ------- metacarpal, cephalic, basilic, accessory veins in arm. What are the insertion procedures for short peripheral catheters? --------- Correct Answer --------- follow guidelines, aseptic technique, 2 attempts per provider, limit of 2 providers, smallest gauge possible to deliver therapy. What are pediatric considerations for short peripheral catheters? --------- Correct Answer --------- Metacarpal, cephalic, basic, scalp and saphenous veins may be used. Use imaging devices to minimize iv attempts and secure with approved devices. length previous recorded, avoid using organic solvents with CVAD dressing changes, hand hygiene, use Alcoholic chlorhexidine gluconate >0.5% (caution with infants under 2 months) with 70% isoprophyl alcohol antiseptic, What should know about removal or replacement? --------- Correct Answer --------- Replace any device ASAP within 48hrs, remove if signs of phlebitis, infection, or malfunction. See if culture i needed on infected device. Position for Non-tunneled CVAD's is flat or slight trendelenburg. Position for PICC's/Midline is position of comfort with arm below the heart. Replace a PIV thats in a lower extremity in adult ASAP, Replacement is 72-96 hours. Replace in child only when clinically indicated. What is Phlebitis and what are some of the causes? --------- Correct Answer --------- Inflammation of the vein most common in superficial vessel. Causes: Chemical, Mechanical, or infectious. What is Infiltration and extravasation and what are some of the causes? --------- Correct Answer --------- Infiltration is the inadvertent administration of medication of fluid into tissue. Extravasation is the inadvertent administration of vesicant or large volume of solution into the tissue. Causes: Vessel trauma , inadequate device securement, traumatic insertion, mulitple venipuncture attempts, use of power injections, presence of a fibrin sheath, dislodged non-coring access needle in implanted port. What is CRBSI and CLABSI and the difference between the two? --------- Correct Answer --------- Catheter-related blood stream infection: most prevalent catheter complication which may occur at insertion or during dwell of time, used when diagnosing as source but not for surveillance. Central Line-associated blood stream infection: lab confirmed bloodstream infection where CL or UC was in place for 2 + calender days on the date of event, device placement is day 1 and in place on the date of event or the day before, used for surveillance purposes. What should you know about Catheter Clearance? --------- Correct Answer --------- Alteplase is currently the only fda approved thrombolytic agent for treatment of dyfunctional CVAD's. Presence of drug precipitate or lipid deposits such as mineral/acidic precipitate/low ph (1-5) may be treated with hydrochloric acid (HCI) per order and policy. What is the site and device selection in CKD stage 3 or greater or serum creatinine level greater than 2.0 mg/dl? --------- Correct Answer --------- Dorsal vein of dominant hand for venipunture because veins in forearm, upper arm, and subclavian are critical for possible hemodialysis fistula. What is the normal International normalized ratio normal range and what values are for anticoagulant therapy and for high intensity anticoagulant therapy? --------- Correct Answer --------- 0.8-1.2 2.00-3.00 2.50-3.50 What is the frequency, hertz, attenuation, and resolution of ultrasound physics? --------- Correct Answer --------- frequency is number of times a phenomena occurs in one second hertz is cycle per second of sound energy attenuation is loss of us energy as it travels through a material or medium. resolution is quality of image with ability to differentiate anatomic structures. Can a patient family or friend translate for procedure? --------- Correct Answer --------- NO. Professional interpreters must be used. What are the different vascular access competencies? --------- Correct Answer --------- Competency: Demonstration of knowledge, skills, and abilities at a defined level of expertise. Clinical competency in nursing: Five levels have been identified being novice, advanced beginner, competent, proficient, and expert. Clinical competency in medicine: specialty area including knowledge, skills, attitudes, and ability to translate. Competency assessment: evaluation measuring a set of skills and knowledge in the right way and right time. What is Interdisciplinary Collaboration? --------- Correct Answer --------- the process in which individuals from different disciplines collaborate to set goals, plan of care, make decisions, and solve problems. What is Cultural diversity? --------- Correct Answer --------- The learned, shared, and transmitted values, beliefs, norms, and life ways of a group that guides their thinking, decisions, and actions. What is a mentor? --------- Correct Answer --------- Person who teaches, guides, coaches, gives advice, and assistance to colleague creating a trusting relationship. What is Incidence, Incidence proportion, incidence rate, prevalence, morbidity, mortality? --------- Correct Answer --------- Incidence: Occurrence of new cases of disease or injury in a population over a certain time period. Incidence proportion: Proportion of an initially disease-free population that develops disease, becomes injured, or dies during a certain time period like attach rate, risk, a probability of getting disease. Incidence rate: Incidence rate or person time rate is a measure of incidence that incorporates time like the number of infections in a year. Prevalence: The number of cases, both old and new, present at a point in time in a defined population like how 10% of patients in the ICU have positive blood cultures during their stay. Morbidity: Rate at which an illness or abnormality occurs like morbidity of diabetes is 30% among hospital patients. Mortality: Death rate. What are the Ethical Principles? --------- Correct Answer --------- Beneficence: The obligation to do no harm. Justice:Fair and unbiased actions Autonomy:The right of a person to make independent decisions. Veracity:The obligation to tell the truth. What should you know about informed consent? --------- Correct Answer --------- Consent is freely given and is verified by patient signature on correct form. 1. Device selection may be limited in pediatric patients due to small size of vessel or patient activity. T or F 2. Do pediatric patients have more or less venous options to choose from? 3. What type of devices preserve vessels and avoid unnecessary anxiety and pain related to venipuncture attempts? 4. Patients may have a preference for or where a line is placed. Give examples of why? --------- Correct Answer --------- 1. T 2. Less, related to their size 3. VADs 4. School, work, bra, seatbelt 5. Give examples of what to assess when considering demographics. 6. Why should an IVAD be placed as shallow as possible? 7. With co-morbidities, insertion of VADs can be complicated. List some co-morbidities to consider. 8. Meaning the side that you would NOT choose to use for VAD placement. I.E. same side as cardiac device. --------- Correct Answer --------- 5. Age, sex, homelessness, disability 6. Easier palpation, increased success of access 7. ESRD, fistulas, venous thrombosis or stenosis, breast cancer, pacemakers, previous or future port placement 8. Ipsilateral 30. 350-400 ml/min 31. Remove excess salt and water from body safely 32. Dual lumen large bore catheter or CVAD 33. AVF, CKD stage 3 or higher, axillary lymph node dissection, stenosis, burns, opening of scar tissue 34. What to consider with morbidly obese patient: what vessel may be more appropriate for CVAD placement? 35. Why might a PICC line placed in the basilic vein in a morbidly obese patient be troublesome? 36. What types of disease can increase the risk for occluded vessels? 37. In pediatric patients with congenital heart disease at the SVC or IVC tip placement is best secondary to longer dwell times. T or F 38. In cases of sepsis or bacteremia, the best device is a PIV if at all possible, but when a central line is indicated, what is important for the line to have? 39. It is acceptable to place a VAD on the ipsilateral arm with a fracture, trauma, infection, orthopedic hardware, amputations, or compromised circulation. T or F 40. If a patient has experienced paralysis on the left side, it is recommended to place the VAD on the ipsilateral or contralateral side? Would that be the patient's left or right side? --------- Correct Answer --------- 34. Cephalic 35. Increased moisture to area, difficult to maintain dry and intact 36. Congenital heart disease (Glenn of Fontan anastomoses) 37. True 38. Antimicrobial if possible 39. False 40. Contralateral side; right side 41. Scalp vein insertions on infants able to roll are a good site. T or F 42. Site determination for VAD is often overlooked. Name some visual observations that may lead to complications for placement. 43. What may prominent superficial veins in the area of the planned CVAD may indicate? 44. If you are using ultrasound to find a vein that changes in size from large to small and back again as it traverses up the arm, what may this represent? 45. For PICCs placed in arm, how should you position the arm ideally? 46. When measuring for PICC placement in upper extremities, what order should you do the measurements? a. Planned insertion site, right clavicular head, 3rd intercostal space b. 3rd intercostal space, left clavicular head, planned insertion site c. Planned insertion site, left clavicular head, 3rd intercostal space --------- Correct Answer --------- 41. False 42. Skin turgor, cuts, edema, ecchymosis, grafts, swelling 43. Neighboring or central vein stenosis or occlusion 44. Distal stenosis or occlusion 45. 90 degrees 46. A 47. Studies are reported that landmark based measurements have as much as a % failure rate? a. 30% b. 50% c. 10% 48. For PICCs inserted in the scalp, how do you measure? a. Planned insertion site, along the jugular vein, right clavicular head, 3rd intercostal space b. Planned insertion site, along jugular artery, left clavicular head, 3rd intercostal space 49. For PICCs inserted in lower extremities, how do you measure? a. Planned insertion site, up leg to umbilicus, continue to the Xyphoid process b. From 3rd clavicular space, along body, down to planned insertion site 50. Veins transport deoxygenated blood from tissues to the right side of the heart. T or F 51. Arteries transport oxygenated blood from left heart to organs and tissues. T or F 52. Veins have thicker vascular walls than arteries. T or F 53. Arteries collapse under pressure. T or F 54. The color of venous blood is bright red. T or F 55. The color of arterial blood is a deep, dark red. T or F --------- Correct Answer --------- 47. A 48. A 49. A 50. True 51. True 52. False 53. False 54. False 55. False 56. Arteries contain valves. T or F 57. The function of the pulmonary vein is the transport of oxygenated blood to the left side of the heart. T or F 58. The pulmonary artery transports blood through the capillary bed of the lungs. What occurs next? 59. The inner most layer of a vessel is? 60. The outer most layer of a vessel is? 61. The middle layer of a vessel is? 62. What layer of a vein or artery, if damaged, can cause a thrombus? 63. The tunica media contains nerve fibers for vasoconstriction and dilation. T or F 64. What layer of an artery vasoconstricts with pain and anxiety? --------- Correct Answer --------- 56. False 57. True 58. O2 and CO2 exchange 59. Tunica intima/endothelium 60. Tunica adventitia 61. Tunica media 62. Tunica intima 63. True 64. Tunica media 65. What kind of tissue will you find in the tunica adventitia layer of veins and arteries? 66. What order does the basilica vein travel up your arm? a. Ulnar medial side of the arm, across the ACF, medial side of upper arm to join brachial veins, to the axillary vein b. Radial lateral side of the arm, across the ACF, medial side of upper arm to brachial veins, to the axillary vein 67. What two veins join to form the axillary vein? 68. What vein runs along the brachial artery and median nerve? 69. You should use caution when accessing the brachial vein in young or nonverbal patients due to their inability to verbalize symptoms of nerve injury which includes pain or numbness. T or F 70. What vein arises from the radial side of the dorsal side of the wrist? 71. What vein travels along the lateral border of the biceps muscle and pectoral border of the deltoid muscle? --------- Correct Answer --------- 65. Connective tissue 66. A 67. Basilica and brachial 68. Brachial 100. Can you use CHG as a prep on a child under the age of 2 months? 101. What is the ideal placement for long term cuffed dialysis CVCs? 102. What does percutaneous mean? 103. What does tunneled mean? 104. What is the difference between tunneled and implanted device? 105. When a catheter tip is placed into the superior vena cava, for long-term use, this is called? --------- Correct Answer --------- 98. True 99. Supine or slight Trendelenburg 100. No 101. Right upper atrium 102. Through the skin 103. Inserter creates subcutaneous tunnel from entrance of vein to exit on the chest area/other area of tunneling 104. Same, except a reservoir is attached to the catheter and inserted under the skin in subcutaneous pocket. 105. Central line 106. What must be done prior to using central lines to confirm proper placement of the catheter tip? 107. When accessing the subclavian or jugular vein, the provider will place the patient in what position, with a rolled towel or sheet under the shoulder of the proposed site? 108. Placing a patient in Trendelenburg when accessing certain vessels decreases the risk of? 109. Permanent central lines are usually placed in surgery, where temporary central lines are usually placed at the bedside. T or F 110. Sterile gauze, or sterile, transparent semipermeable dressing are acceptable dressings on insertion site. T or F 111. Change gauze dressing every how many hours? 112. Change transparent dressings with a chlorhexidine saturated sponge every _to_ days. 113. Should use gauze dressing on patients who are diaphoretic, or if the site is oozing or bleeding. T or F 114. Placement of a gauze dressing UNDER a transparent dressing should be considered (treated as a) gauze dressing and should be changed every how many days? 115. All dressings must be occlusive on all lines. T or F 116. Using scissors while changing dressings is acceptable. T or F 117. How does wire shearing occur? --------- Correct Answer --------- 106. Chest x-ray 107. Trendelenburg 108. Pneumothorax 109. True 110. True 111. 48 hours 112. 5 to 7 days 113. True 114. 2 days 115. True 116. False 117. Re-advancing the wire back into the catheter 118. Document a dressing change along with site condition and patient response according to policy. T or F 119. What should you do if the needleless connect is disconnected? 120. It there is blood or debris within the needless connector, prior to drawing blood culture sample from catheter, upon contaminations, or according to policy or manufacturer's directions. What is this an example of? 121. What types of products are acceptable for disinfecting the hub prior to each access? 122. Heparin lock solution of how many units/mL is used before removal of an access needle from an implanted port and/or for periodic access and flushing? 123. The recommended and preferred heparin lock solution is how many units/mL? 124. Heparin lock solution for hemodialysis catheters is how many units/mL after each use? 125. What is an anti-infective central vascular access device? 126. A 3-port temporary catheter placed at bedside into either subclavian or jugular and tip threaded into the SVC is? 127. Triple Lumen CVC catheter has a distal port that is 16 gauge, medial port is 18 gauge, and proximal port is 18 gauge. T or F --------- Correct Answer --------- 118. True 119. Clamp the catheter 120. Removal or changing of needleless connector 121. Alcohol, tincture or iodine, or chlorhexidine gluconate/alcohol combination prior to each access 122. 100 123. 10 124. 1000 125. Devices coated or impregnated with chlorhexidine and silver sulfadiazine, minocycline and rifampin, and silver ion. Make sure they are not used on patients with allergies to the item. 126. Triple lumen catheter 127. True 128. What are Hickman catheters used for? 129. Access implantable ports using aseptic technique with a non-coring needle called? 130. How do you determine the length of the Huber needle for insertion? 131. Power injectable ports can withstand 5 mL/sec and 300 psi when using a power injectable Huber needle. T or F 132. It is acceptable to access a power port with a non-power injectable non-coring needle. T or F 133. Fracturing of a non-power injectable port is possible if misidentified as a power port and receives injectable contrast from CT. T or F 134. If a central line becomes clotted, the physician may order fibrinolytic therapy. What would be an example of one? 135. It takes approximately how many hours for the site of a central line to be healed? 136. When culturing the tip of a catheter, what needs to be used to clip the tip? 137. Considerations to be made when selecting site for IVs. What are they? 138. Use the smallest size of cannula to meet the patient's prescribed therapy needs. T or F --------- Correct Answer --------- 128. Long-term (several months to years) cath placed surgically into subclavian and cath tip threaded into superior vena cava. The remaining cath is tunneled underneath skin in chest wall with exit site just below the nipple area: single or dual lines. 129. Huber needle 130. Feel and depth of adipose tissue above the port 131. True c. Criminal Law --------- Correct Answer --------- 147. A 148. A 149. A 150. A 151. A 152. A 153. A 154. A 155. Each person is responsible for his/her own "wrong doing". No other person may assume responsibility for another. a. Rule of personal liability b. Negligence c. Malpractice d. Sentinel event 156. Serious, undesirable outcome of care that requires investigation. a. Sentinel event b. Negligence c. Malpractice d. Criminal law 157. Level "A" type of evidence based practice is based on randomized control trials (rct). T or F 158. Well-designed control trials without randomization are less strong in validity due to the lack of control of variable at the initiation of the trial. Some concerns or problems with this type of trial include intentional or unintentional bias in participant enrollment is evidence based practice level: a. B b. C c. D d. A 159. Consensus viewpoint and or expert opinion is a study that obtains a majority agreement from clinical experts about a specific practice when no quantitative or qualitative studies exist related to a practice area. This is an evidence based practice level: a. C b. D c. A d. B 160. Primary sepsis is when a bloodstream infection occurs without any other site of infection in the body with the same organism cultured off of the catheter. T or F 161. A wound, UTI, respiratory infection that causes a bloodstream infection is called secondary sepsis. T or F --------- Correct Answer --------- 155. A 156. A 157. True 158. A 159. A 160. True 161. True 162. Staohylococcus epidermis gram + is the most common related organism with IV catheter infections. T or F 163. Gram negative organisms are the leading cause of deaths from sepsis. T or F 164. The presence of pathogens and their toxins in the blood is called sepsis. T or F 165. Chills, hectic fevers, low BP, nausea/vomiting, confusion, are signs and symptoms of sepsis. T or F 166. Lethargy, poor intake, and confusion are signs and symptoms in sepsis of an immune compromised patient. T or F 167. Digital vein's anatomic route is along the lateral-distal portion of the fingers. T or F 168. According to the CDC, pathogenic determinants of CRBSI (catheter related blood stream infections) are: A. Material of which the device is made B. The host factors consisting of protein adhesions, such as fibrin and fibronectin, that form a sheath around the catheter C. The intrinsic virulence factors of the infectiong organism, including the extracellular polymeric substance a. A and B b. B and C c. A and C d. All of the above 169. Mechanical phlebitis may be related to vein wall irritation, which can come from too large a catheter for the vasculature. T or F 170. Chemical phlebitis may be related to infusates with dextrose >10% or high osmolarity >900 mOsm/L. T or F --------- Correct Answer --------- 162. True 163. True 164. True 165. True 166. True 167. True 168. D 169. True 170. True 171. Subclavian approach to CVADs increases the risk of "pinch-off" of the catheter. T or F 172. Using landmarks as an approach to subclavian access for central lines has the risks of pneumothorax, hemothorax, and subclavian arterial puncture. T or F 173. IH recommends subclavian approach over IJ site for lowering risk of CLABSI. T or F 174. Left brachiocephalic vein is longer compared to the right brachiocephalic vein. T or F 175. The femoral vein, when used for short-term access, is associated with a higher risk of CLABSI compared to other sites. T or F 176. The posterior auricular vein descends behind the ear and the pathway is tortuous. T or F 177. Saphenous vein provides an alternative site for lower extremity CVC, but should not be considered for a crawling patient. T or F 178. Umbilical vein is patent for 1 week post birth and can have a single or double lumen catheter inserted; the catheter tip must reside above the level of the diaphragm. T or F 179. The brachial artery is not recommended for pediatric patients due to the absence of collateral blood flow. T or F 180. Wound healing due to comorbidities, such as DM II, steroid use, edema, etc, should be considered when placing a catheter, and nutritional status should be considered to promote wound healing. T or F 181. Diet, rotation/turning, movement to promote blood flow, all help with promotion of wound healing in patients. T or F 182. For pediatric patients with congenital heart disease, the SVC or IVC tip placement is safer and has longer dwell times. T or F --------- Correct Answer --------- 171. True 172. True 173. True 174. True 175. True 176. True 177. True 178. True 179. True 180. True 181. True 182. True 183. Collagen and platelet activation occurs when catheter tip is infusing against the vein wall, or catheter movement causes damage or trauma to vein endothelium. T or F 184. Cystic fibrosis patients can have venous stenosis due to frequent IV therapy. T or F 185. Age 0-18 month child has separation anxiety and should have encouragement of parent and calm environment. T or F 186. 18 month-3 year old toddler is egocentric, may need mild to moderate sedation and a comfort item during procedure. T or F 187. You should reassure a child that he/she hasn't done anything wrong and that the procedure is not a form of punishment for what age group? a. 3-5 year old preschooler b. 18 months-3 years toddler c. 6-12 years school age 188. What are the purposes of IV placement? a. NPO b. Fluid loss c. Blood loss d. Drug administration What is the gauge scale? -------- Correct Answer -------- Measurement of the outside size(diameter) of a catheter As the gauge number gets larger, what happens to the catheter size? -------- Correct Answer -------- It gets smaller. What is the gauge range of IV catheters? -------- Correct Answer -------- 24ga to 12 ga Why are all I.V. devices manufactured in the USA are required to be radiopaque? -------- Correct Answer -------- To facilitate location of catheter emboli in the event of shearing or fracture From what two materials are IV catheters made? -------- Correct Answer -------- Silicone and Polyurethane Which catheter material can be affected by alcohol? -------- Correct Answer -------- Polyurethane What are the indications for short peripheral catheters? -------- Correct Answer -------- - Infusions projected for 6 days or less -Non-irritating medications and solutions -Non-vesicant medications and solutions What are contraindications for short peripheral catheters? -------- Correct Answer -------- -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 What veins are used for short peripheral catheters? -------- Correct Answer -------- Metacarpal, cephalic, basilic and accessory veins of the arms How many short peripheral catheter insertion attempts per healthcare provider are allowed? -------- Correct Answer -------- 2 What additional veins in pediatrics may be used for non-irritating/non-vesicant infusions? -------- Correct Answer -------- Metacarpal, cephalic or basilic, scalp veins if <18mo What are the indications for a midline catheter? -------- Correct Answer -------- -Infusions projected for 6 days- 4 weeks -Non-irritating medications and solutions -Non-vesicant medications and solutions What are contraindications for a midline? -------- Correct 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? -------- Correct 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? -------- Correct Answer -------- A product that is specifically designed and labeled as a peripheral midline catheter What barrier precautions should be considered for midline placement? -------- Correct Answer -------- Maximun sterile barrer Why should a PICC device NOT be used for midline placement? -------- Correct 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? -------- Correct Answer -------- One inch below the axillary area For midline placement, what alternative veins can be considered in pediatric patients? -- ------ Correct Answer -------- Scalp veins Popliteal veins Saphenous veins What are the indications for non-tunneled catheters? -------- Correct Answer -------- Short term central vein access Emergency central vein access What are the contraindications for non-tunneled catheters? -------- Correct 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? -------- Correct 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? -------- Correct Answer - ------- Anti-microbial catheters What type of barrier precautions are required for non-tunneled catheter placement? ----- --- Correct Answer -------- Maximun sterile How should a patient be positioned for non-tunneled catheter placement? -------- Correct Answer -------- slight Trendelenburg position Why is a patient placed in slight Trendelenburg position for non-tunneled catheter placement? -------- Correct Answer -------- to avoid the possibility of air emboli during the placement procedure In non-tunneled catheter or PICC placement., what should always be avoided when accessing veins? -------- Correct Answer -------- Blind-stick attempts. Prior to any infusion of non-tunneled catheters, how should tip location be confirmed? -- ------ Correct Answer -------- ECG technology or radiograph What must be obtained prior to ANY infusion of a non-tunneled catheter or a PICC line? -------- Correct Answer -------- A free flowing blood return What is the optimal tip location for a non-tunneled and PICC catheters? -------- Correct Answer -------- Cavoatrial juncture (CAJ) If inserted through the femoral vein, what the optimal tip location for a non-tunneled and PICC catheters? -------- Correct Answer -------- Inferior vena cava (IVC) above the level of the diaphragm Why is the femoral vein is commonly used in pediatric critical care units for non- tunneled catheter placement? -------- Correct Answer -------- Due to ease of insertion in young patients Why may the jugular vein be the preferred point of insertion in very young children for non-tunneled catheters? -------- Correct Answer -------- To avoid a pneumothorax What are the indications for placement of a PICC line? -------- Correct Answer -------- - Patients who require central venous access when the duration of the infusions are unknown -Infusion of irritating medications -Infusion of vesicant agents How is the port secured inside the patient? -------- Correct Answer -------- Port is sutured into a subcutaneous pocket under the skin Accessing an implanted port is always what type of procedure? -------- Correct Answer -- ------ Sterile procedure What type of needle is used to access an implanted port? -------- Correct Answer -------- Non-coring needle What are power-injectable catheters? -------- Correct Answer -------- Power-injectable catheters are made of polyurethane and engineered to withstand high pressure >300 pounds per square inch (PSI) What are power injection catheters used for? -------- Correct 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? -------- Correct Answer -------- As an alternative to venous access in emergency situations What are contraindications for intraosseous placement? -------- Correct Answer -------- - Trauma or fracture in the area of access -Bone disease What are possible selection sites for IO placement? -------- Correct Answer -------- Sternum, iliac crest, femur or tibia (away from the growth plate in the tibia) What may be administered through an IO device? -------- Correct Answer -------- I.V. fluids, blood and medications In emergency situations, in what population are IO devices often used? -------- Correct Answer -------- Infants and children What are indications for dialysis or apheresis catheters? -------- Correct Answer -------- Hemodialysis, apheresis for plasma or platelets What are possible vessels selected for dialysis/apheresis catheters? -------- Correct Answer -------- Jugular, subclavian, or femoral vein Generally, what size are dialysis or apheresis catheters? -------- Correct Answer -------- Catheter lumen size is generally 13 to 16 gauge Why are dialysis/apheresis catheters more rigid? -------- Correct Answer -------- To facilitate rapid blood flow Which catheter insertions are surgical precures and required anesthesia? -------- Correct Answer -------- Implanted ports, tunneled catheters, Dialysis/apheresis catheters. Where is the optimal tip location for a dialysis/apheresis catheter? -------- Correct Answer -------- Upper right atrium What are indications for an aerial catheter? -------- Correct Answer -------- Monitoring arterial pressure, arterial blood draws and organ specific infusions What are contraindications for radial artery catheters? -------- Correct Answer -------- Lack of adequate arterial circulation via the ulnar artery determined by an Allen's Test prior to catheter insertion What vessels are selected for placing arterial catheters? -------- Correct Answer -------- Radial, brachial, axillary, or femoral vein What is the indication for a Pulmonary artery catheter? -------- Correct Answer -------- Assessment of cardiac function What are contraindications for a PA catheter? -------- Correct Answer -------- Mitral stenosis Right heart mass Tricuspid or pulmonary mechanical valves What vessels are preferred for PA catheter placement? -------- Correct Answer -------- The right subclavian or internal jugular In which type of catheter placement is cardiac monitoring used during insertion? -------- Correct Answer -------- Pulmonary Artery catheters. What is the indication for an Aquapheresis catheter? -------- Correct Answer -------- Diuretic resistant CHF (ultrafiltration to remove excess fluid/sodium) What is the contraindication for an aquapheresis catheter? -------- Correct Answer -------- Lack of an accessible basilic vein in upper arm What vessel is selected for an aquapheresis catheter? -------- Correct Answer -------- Basilic vein above the antecubital bend For what things are Aquapheresis catheters are not recommended? -------- Correct Answer -------- Not recommended for infusions of fluids or medications What is the optimal tip location for an aquapheresis catheter? -------- Correct Answer ---- ---- 1 -2 centimeters below the axilla What vessels are available to use with pediatric umbilical catheters? -------- Correct Answer -------- 2 umbilical arteries 1 umbilical vein During what time frame may umbilical vessels be accessed? -------- Correct Answer ----- --- Up to the 4th day of life. What are appropriate uses of an umbilical catheter located in a VEIN? -------- Correct Answer -------- -Blood sampling -All infusates What are appropriate uses of an umbilical catheter located in an ARTERY? -------- Correct 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? -------- Correct Answer -------- Physical exam Site Determination: Prominent superficial veins in the area of planned CVAD may indicate what? -------- Correct Answer -------- Neighboring or central vein stenosis or thrombosis Site Determination: What should you assess upon physical exam when determining potential CVAD sites? - ------- Correct 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? -------- Correct Answer -------- They denote probable thrombosis Site Determination: What might variance in the vein diameter along the vein pathway do? -------- Correct Answer -------- Variance in the vein diameter along the vein pathway which may interfere with catheter advancement