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VA-BC Certification Study Material Questions with Solutions
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 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
liability for the nurse.
22. What is optimal tip location for a midline catheter?: One inch below the axillary area
23. For midline placement, what alternative veins can be considered in pedi- atric patients?: Scalp veins
Popliteal veins Saphenous veins
24. What are the indications for non-tunneled catheters?: Short term central vein access
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?: Maximun 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
31. 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
37. Why may the jugular vein be the preferred point of insertion in very young children for non-tunneled
catheters?: To avoid a pneumothorax
38. What are the indications for placement of a PICC line?: -Patients who require central venous access when
the duration of the infusions are unknown -Infusion of irritating medications
-Severe coagulopathy -Cellulitis (affecting intended insertion site)
47. which vessels are selected for tunneled catheters?: a. Subclavian veins
b. Jugular veins c. Femoral veins
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
50. 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
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
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 -2 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.
94. Site Determination:
Why should you avoid non-compressible or partially compressible target veins?: They denote probable thrombosis
95. Site Determination:
What might variance in the vein diameter along the vein pathway do?: Variance in the vein diameter along the vein pathway which may interfere with catheter advancement
96. Site Determination:
When assessing to patient for potential CVAD sites why should you look at a recent CXR?: To check for pacemakers or Automatic Implantable Cardioverter Defibrillator (AICD), spinal rods or other implanted devices
97. Skin Preparation:
What is an antiseptic?: A chemical agent that inhibits microorganisms on skin or tissue and has an effect of limiting or optimally preventing infection.
98. Skin Preparation:
What is a disinfectant?: A chemical agent that destroys microorganisms on inani- mate objects
99. Skin Preparation:
What is aseptic technique?: -A specific type of aseptic technique where key areas of items to be used for an infusion cannot be touched prior to insertion. -Once a site has been disinfected it can only be touched by the clinician if wearing sterile gloves.
-All injection ports on I.V. tubing and end caps on catheter lumens MUST be properly disinfected prior to access
100. 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
101. 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
INFANTS AND CHILDREN < 2 MONTHS OF AGE
107. Site preparation:
What are iodophors?: Solutions of iodine in complexes that contain a low amount of free iodine
108. Site preparation:
What solutions contain up to l0% of an iodine complex, and provide up to 1% free iodine for skin antisepsis: Povidone iodine (e.g. Betadine™)
109. Site preparation:
After the application of povidone iodine, what should NOT be applied?: Alcohol
110. Site preparation:
What is effective against gram-positive and gram-negative bacteria, fungi, and viruses; but has minimal effect on bacterial spores?: Tincture of iodine
111. Site preparation:
For an antiseptic effect to occur with Iodophors, what must happen?: The antiseptic must have contact with the skin for two minutes or more to release free iodine
112. Site preparation:
Once applied, how long is the residual effect of Iodophors?: Approximately two hours
113. Site preparation:
if iodine comes into contact with organic matter, such as blood, what hap- pens?: It is neutralized and no longer effective
120. Site Preparation:
What is the residual effect on the skin of alcohol?: Alcohol lacks residual antimicrobial property once the alcohol evaporates
121. Site preparation:
Which antiseptic has a volatile or flammable nature until completely dry?: Al- cohol
122. Site Preparation:
What effect can alcohol have on the skin?: Alcohol irritates and dries the skin
123. What is the purpose of a disinfectant wipe?: To kill bacteria, viruses, and fungi on inanimate objects
124. Surface disinfectant are used on what type of surfaces?: Use on hard, nonporous surfaces and
equipment
125. In line placement, when are surface disinfectants used?: prior to setting up sterile field and between
patient use
126. What is the purpose of adhesive remover?: Removes sticky residue from tape or dressings
b. Allows easy removal of transparent dressings, butterfly stitches and stabilization devices during dressing
changes
c. Decreases skin trauma and tears
d. Do not use directly on insertion site
127. Is it okay to use adhesive remover directly on Insertion site?: No
