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

Erythema, warmth, and tenderness tracking along the vein indicate phlebitis or thrombophlebitis — inflammation of the vein wall, a known complication of peripherally inserted central catheters.

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

Blood cultures must be drawn from both the central line and a peripheral site before antibiotics are administered to identify the organism, differentiate CLABSI from local infection, and optimize treatment.

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

The pulsatile push-pause flushing technique creates turbulent flow inside the catheter lumen, dislodging fibrin deposits that can cause occlusion. Clamping during positive pressure prevents backflow of blood into the lumen.

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

When de-accessing an implanted port, maintaining positive pressure (by keeping the plunger pressed forward) while withdrawing the Huber needle prevents blood from being aspirated back into the port septum and reservoir, which can cause clot formation.

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

Partial resistance to flush with poor aspiration suggests a fibrin sheath or fibrin flap around the catheter tip — a common cause of 'withdrawal occlusion' that responds to alteplase instillation to dissolve the fibrin.

CPHON Exam Practice Test

CPHON Exam Practice Test

CPHON Central Line Care and Vascular Access