CPHON Central Line Care and Vascular Access

Question 1

A child with a newly placed PICC line develops erythema, warmth, and tenderness along the arm vein pathway 48 hours after insertion. The nurse suspects:

Accepted Answer

Phlebitis or thrombophlebitis of the accessed vein

Answer

Line-associated bloodstream infection (CLABSI)

Answer

Air embolism

Answer

Pneumothorax

Question 2

What is the first priority action when a nurse suspects a central line-associated bloodstream infection (CLABSI) in a pediatric oncology patient?

Accepted Answer

Obtain blood cultures from the central line and a peripheral site before administering antibiotics

Answer

Remove the central line immediately

Answer

Start empiric antibiotics immediately without cultures

Answer

Apply topical antiseptic to the exit site

Question 3

When flushing a Broviac/Hickman central venous catheter, which technique is most important for preventing catheter occlusion?

Accepted Answer

Use a pulsatile (push-pause) technique with 10 mL normal saline and positive pressure clamping

Answer

Continuously inject at a constant slow rate

Answer

Flush with heparinized saline using gravity flow only

Answer

Use a 1 mL syringe to create maximum pressure

Question 4

A Mediport (implanted venous access port) is accessed with a non-coring Huber needle. When removing the Huber needle after completing an infusion, which step is essential?

Accepted Answer

Maintain positive pressure on the syringe plunger while withdrawing the needle to prevent blood backflow into the port chamber

Answer

Clamp the extension tubing immediately before needle removal

Answer

Flush with sterile water instead of normal saline for the final flush

Answer

Leave the needle in place for 24 hours after access to minimize skin trauma

Question 5

A nurse attempts to flush a tunneled central line and encounters resistance. The patient reports no discomfort and the line flushes partially but aspirates poorly. This presentation is most consistent with:

Accepted Answer

Fibrin sheath or tip occlusion requiring alteplase (tPA) instillation

Answer

Line migration into the jugular vein

Answer

Catheter rupture requiring emergency removal

Answer

Air lock requiring vigorous flushing

Question 6

Which site assessment finding requires immediate removal of a peripheral IV catheter in a pediatric oncology patient receiving vesicant chemotherapy?

Accepted Answer

Swelling, blanching, or pain at the infusion site indicating extravasation

Answer

Slight redness at the catheter insertion site without swelling

Answer

Blood return not visible in the tubing

Answer

IV rate running 10 mL/hr slower than prescribed