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VA-BC Study Guide Questions and
Answers 2025/
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? 20 - 24 Bright red blood Preform ABG Patient needs one dose of vanco what would you recommend? How do you determine IO position placement? 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? 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? 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? 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? 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? 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? 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? media respect there cultural beliefs on death. What should you consider for Device Selection in adults? What are the pediatric considerations? 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? infusion for 6 days or less. non-irritating and non-vesicant medications and solutions.
What are the supplies for a non-tunneled catheters? Non-tunneled percutaneous venous catheter, sterile procedural insertion tray, max sterile barrier precautions, Ultrasound, normal saline flush, Heparin flush, dressing What is the Optimal tip location for non-tunneled catheters? Cavoatrial juncture, inferior vena cava at diaphragm if inserted in femoral vein. What are the indications for a PICC? Patients who require a central venous access when duration is unknown. irritating and vesicant agents. What are the Contraindications for a PICC? 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? Basilic, brachial, cephalic vein. What are the insertion procedures for a PICC? 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? PICC device, Sterile insertion tray, Ultrasound, ECG system, normal saline flush, heparin flush. Caval atrial juncture What are the Pediatric considerations for a PICC? Alternative vein selection like scalp and popliteal vein. Heparin may decrease catheter occlusion. What are the indications for a Tunneled Catheters? Infusions for months or years, Apheresis, What are the contraindications for a Tunneled Catheters? Current infection, severe coagulopathy, Cellulitis on insertion site. What are the vessel selection for a tunneled catheter? Subclavian, Jugular, and Femoral vein. What is the insertion procedure for tunneled catheter? 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? 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?
Cavoatrial junction or Inferior vena cava. Catheter tip location (assess as the child grows to maintain in SVC. What are the Indications and contraindications for a Implanted venous port? 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 site selections for implanted venous port? Peripheral: Basilic or cephalic vein Central: Subclavian, Jugular, femoral vein. What are the considerations for implanted venous port access? comfort for location of port, depth must be shallow enough to palpate and insert a non-coring access needle safely to maintain access into the port septum. What are the insertion procedures for implanted venous port access? Follow guidelines, scheduled operative/radiology procedure, sedation, site may be upper chest or lower abdominal side area depending upon thevein accessed, port is sutured into a subcutaneous pocket under the skin, different designs shapes and types, confirm with fluoroscopy or radiography, follow policies, obtain free flowing blood. What is the optimal tip location for implanted venous port? Cavoatrial junction, inferior vena cava above level of diaphragm if inserted into femoral vein. What are the Indications and contraindications for Intraosseous Devices? 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? 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? 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? Jugular, Subclavian or femoral vein. What is the Insertion procedures and Supplies for Dialysis or Apheresis Catheters? 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.
Discuss the dressing changes for CVAD's/Midlines/PIV's? Transparent semipermeable membrane (TSM) polyurethane dressing is recommended, as it allows for direct visualization and for release of moisture produced by skin. TSM dressings need to be changed every 7 days, or when wet, loose, or soiled. Gauze dressing are used for bleeding and are changed every 2 days, when wet, loose, or soiled. CVADs/Midlines should use an all inclusive kit or cart, use clean gloves, remove dressing, assess site for complications, measure external length of catheter compare to 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? 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? 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? 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? 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? 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?
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? 0.8-1. 2.00-3. 2.50-3. What is the frequency, hertz, attenuation, and resolution of ultrasound physics? 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? NO. Professional interpreters must be used. What are the different vascular access competencies? 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? the process in which individuals from different disciplines collaborate to set goals, plan of care, make decisions, and solve problems. What is Cultural diversity? 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? 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? 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.
- Age, sex, homelessness, disability
- Easier palpation, increased success of access
- ESRD, fistulas, venous thrombosis or stenosis, breast cancer, pacemakers, previous or future port placement
- Ipsilateral **9. Relating to the side you would choose to place a VAD. I.E. opposite side of a cardiac device.
- How long is recommended to wait to use a side with a recent cardiac device implanted before using for VAD? a. 6 months b. 1 year c. 6 weeks d. Never
- CVAD insertion in the presence of an IVC filter can inadvertently trap wires in the filter. T or F
- Why is important to avoid CVAD or PVAD devices in the lower extremities of infants and toddlers?
- PIV devices are recommended for use with what type of infusion therapy?
- Power injectable catheters are made of?**
- Contralateral
- A
- T
- Interferes with crawling and ambulating
- Non-vesicants, >900 mOsm/L
- Polyurethane **15. How much pressure are power injectable ports rated to withstand?
- Patients with known septicemia, neutropenia or thrombocytopenia may benefit from what specific type of VAD?
- IVAD is indicated for complex chemo or infusion therapy > than?
- What type of CVAD is recommended for patients with acute leukemia and other cancers and**
blood and bone marrow transplants?
19. Who are tunneled CVADs used more frequently with?
300 pounds per square inch (PSI)
- PICC with antimicrobial properties
- 3 months
- Tunneled CVAD
- Infants and younger children **20. IVADs are used less frequently with pediatric population. Why?
- Chemotherapy/biotherapy: CVAD required for tx > how long, for vesicant tx > how long, or continuous tx > than how long?
- Chemo/biotherapy: A blood return is not needed prior to infusion therapy. T or F
- Why should chemotherapy lines and infusions not be interrupted if at all possible?
- What are the recommended devices for chemotherapy?
- When administering TPN, any CVAD is acceptable to use. T or F
- For infants and toddlers receiving TPN, what access devices is recommended?**
- Size of patient, fear of needle, increased risk of dislodgement
- 3 months, 1 hour, 24-96 hours
- F
- Increased patient risk of infection, increased exposure risk to clinician
- Tunneled CVAD or PICC
- T
- Tunneled CVAD **27. Intravenous infusion of multiple and/or simultaneous medication sand solutions may require a multi-lumen catheter. Is if best to check for compatibilities prior to choosing the number of lumens?
- For medications such as Remodulin, or Prostacylin, what type of access device is best?
- For Stem Cell Apheresis and Plasmapheresis a large bore catheter is required for flow rates**
- Cephalic
- Increased moisture to area, difficult to maintain dry and intact
- Congenital heart disease (Glenn of Fontan anastomoses)
- True
- Antimicrobial if possible
- False
- Contralateral side; right side **41. Scalp vein insertions on infants able to roll are a good site. T or F
- Site determination for VAD is often overlooked. Name some visual observations that may lead to complications for placement.
- What may prominent superficial veins in the area of the planned CVAD may indicate?
- 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?
- For PICCs placed in arm, how should you position the arm ideally?
- 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**
- False
- Skin turgor, cuts, edema, ecchymosis, grafts, swelling
- Neighboring or central vein stenosis or occlusion
- Distal stenosis or occlusion
- 90 degrees
- A **47. Studies are reported that landmark based measurements have as much as a % failure rate? a. 30% b. 50% c. 10%
- 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
- Veins transport deoxygenated blood from tissues to the right side of the heart. T or F
- Arteries transport oxygenated blood from left heart to organs and tissues. T or F
- Veins have thicker vascular walls than arteries. T or F
- Arteries collapse under pressure. T or F
- The color of venous blood is bright red. T or F
- The color of arterial blood is a deep, dark red. T or F**
- A
- A
- A
- True
- True
- False
- False
- False
- False **56. Arteries contain valves. T or F
- The function of the pulmonary vein is the transport of oxygenated blood to the left side of the heart. T or F
- The pulmonary artery transports blood through the capillary bed of the lungs. What occurs next?
- The inner most layer of a vessel is?
- The outer most layer of a vessel is?
- The middle layer of a vessel is?
- What layer of a vein or artery, if damaged, can cause a thrombus?
- The tunica media contains nerve fibers for vasoconstriction and dilation. T or F
- What layer of an artery vasoconstricts with pain and anxiety?**
**73. Who would you need clearance with to access the axillary vessel?
- The subclavian vessels run from the outer border of the 2nd rib to the medial border of the anterior scalene muscle. T or F
- What is another name for the innominate vein?
- Subclavian approach lowers risk for CLABSI than IJ approach. T or F
- What vein is formed at the root of the neck by the union of the ipsilateral internal jugular and subclavian veins?
- What degree does the brachiocephalic vein enter the SVC?
- This vessel is the first choice for VAD placement in the neck.
- Although subclavian entrance is lower risk for infection, why is the IJ the vein of choice for tunneled implanted ports?**
- Axillary
- Nephrologist
- False- 1st rib
- Brachiocephalic
- True
- Brachiocephalic
- 90 degrees
- IJ
- Direct route to brachiocephalic; helps avoid pinch off syndrome **81. What vessel is the easiest to access for an emergency short term IV access?
- What vessel forms from the confluence of the left and right brachiocephalic veins?
- Does the SVC have valves?
- What portion of the SVC is ideal for CVAD tip placement?**
**85. The SVC allows for 2 liters of blood flow per minute. T or F
- This vessel forms from the confluence of the iliac veins and is located below the diaphragm.
- CVADS that are placed in the lower extremities should have their catheter tip above or below the level of the diaphragm?
- This vessel lies within the femoral triangle in the inguinal femoral area.**
- EJ
- SVC
- No
- Lower third
- True
- IVC
- Above
- Femoral **89. Locating the femoral vein is done by palpating the point of maximal pulsation of the femoral artery, immediately below the level of the inguinal ligament and marking a point approximately 0. cm medial to the pulsation. T or F
- Ambulatory patients are an absolute contraindication of femoral central venous access due to risk of catheter fracture or migration. T or F
- Relative contraindications of femoral central venous access include presence of bleeding disorders, distortion of anatomy due to injury or deformity, previous long-term venous catheterization, absence of a clearly palpable femoral artery, history of vasculitis, previous injection of sclerosis agents, or previous radiation therapy. T or F
- The six alternative veins for difficult access are: Hepatic, Azygos, Posterior auricular, Saphenous, Popiteal, and Umbilical. T or F
- The umbilical vein can be accessed after 1 week of birth. T or F
- This vein is located behind the ear is called posterior auricular. T or F
- This vein is located posterior to the SVC is?
- The vein is located above the ankle is?
- What artery is most often used for arterial lines?**
- True
- True
- True
**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?
- Placing a patient in Trendelenburg when accessing certain vessels decreases the risk of?
- Permanent central lines are usually placed in surgery, where temporary central lines are usually placed at the bedside. T or F
- Sterile gauze, or sterile, transparent semipermeable dressing are acceptable dressings on insertion site. T or F
- Change gauze dressing every how many hours?
- Change transparent dressings with a chlorhexidine saturated sponge every to days.
- Should use gauze dressing on patients who are diaphoretic, or if the site is oozing or bleeding. T or F
- 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?
- All dressings must be occlusive on all lines. T or F
- Using scissors while changing dressings is acceptable. T or F
- How does wire shearing occur?**
- Chest x-ray
- Trendelenburg
- Pneumothorax
- True
- True
- 48 hours
- 5 to 7 days
- True
- 2 days
- True
- False
- 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
- 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?
- What types of products are acceptable for disinfecting the hub prior to each access?
- 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?
- The recommended and preferred heparin lock solution is how many units/mL?
- Heparin lock solution for hemodialysis catheters is how many units/mL after each use?
- What is an anti-infective central vascular access device?
- A 3-port temporary catheter placed at bedside into either subclavian or jugular and tip threaded into the SVC is?
- 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**
- True
- Clamp the catheter
- Removal or changing of needleless connector
- Alcohol, tincture or iodine, or chlorhexidine gluconate/alcohol combination prior to each access
- 100
- 10
- 1000
- 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.
- Triple lumen catheter
- True **128. What are Hickman catheters used for?
- Access implantable ports using aseptic technique with a non-coring needle called?**
