CPHON Central Line Care and Vascular Access 2

Question 1

What is the primary advantage of a tunneled central venous catheter (e.g., Broviac or Hickman) over a non-tunneled central line in pediatric oncology?

Accepted Answer

The subcutaneous tunnel reduces CLABSI risk and allows long-term use over months to years

Answer

Tunneling the catheter under the skin creates a mechanical barrier to bacterial migration from the skin exit site to the bloodstream, reduces CLABSI rates, and makes the catheter suitable for long-term use (months to years) compared to non-tunneled devices.

Question 2

A nurse is preparing to access an implanted venous port in a 7-year-old for chemotherapy. In what order should the following steps be performed?

Accepted Answer

Apply topical anesthetic → palpate septum → clean with chlorhexidine → insert Huber needle → verify placement by aspirating blood → flush with normal saline

Answer

The correct sequence for port access is: apply topical anesthetic (well in advance) → palpate the port septum → clean with chlorhexidine antiseptic → insert Huber needle perpendicular to septum → verify with blood aspiration → flush with normal saline.

Question 3

A 5-year-old's central line dressing appears soiled and has lifted at one edge. The catheter was last dressed 5 days ago. The nurse should:

Accepted Answer

Perform an immediate dressing change using sterile technique with chlorhexidine-based antiseptic

Answer

A soiled, non-intact dressing requires immediate change regardless of the usual schedule. The compromised dressing no longer protects the exit site from microorganism entry, increasing CLABSI risk.

Question 4

Which action violates best practice when drawing blood cultures from a pediatric central venous catheter?

Accepted Answer

Using the same catheter lumen for blood draw and antibiotic infusion simultaneously

Answer

Drawing blood cultures through a lumen that is simultaneously used for antibiotic infusion risks contaminating the culture with the antibiotic, leading to false-negative cultures and inaccurate pathogen identification.

Question 5

A child is receiving a continuous infusion through a double-lumen Broviac when the proximal lumen tubing disconnects accidentally. The most immediate nursing action is:

Accepted Answer

Clamp the proximal catheter hub immediately, then apply a sterile cap while maintaining aseptic technique

Answer

Immediate clamping of the disconnected lumen prevents air entrainment (air embolism) and blood backflow. A sterile cap should then be placed on the hub using aseptic technique. The hub and connection should be cleaned with antiseptic before reconnecting new tubing.

CPHON Exam Practice Test

CPHON Exam Practice Test

CPHON Central Line Care and Vascular Access 2