CRNI Central Venous Access Devices Practice Test 1 — Questions and Answers
Question 1: Which central venous access device is most appropriate for a patient requiring intermittent IV chemotherapy over 12 months?
- Peripherally inserted central catheter (PICC)
- Non-tunneled central venous catheter
- Implanted venous access port (Correct answer)
- Midline catheter
Correct answer: Implanted venous access port
An implanted venous access port is most appropriate for long-term intermittent therapy such as chemotherapy over 12 months. Ports are fully implanted beneath the skin, reducing infection risk and allowing patients to swim and bathe normally between treatments. They require only monthly flushing when not in use.
Question 2: What is the primary advantage of a tunneled central venous catheter over a non-tunneled catheter?
- Easier insertion technique
- Lower cost
- Reduced catheter-related bloodstream infection due to the subcutaneous cuff (Correct answer)
- Higher flow rates
Correct answer: Reduced catheter-related bloodstream infection due to the subcutaneous cuff
Tunneled catheters have a subcutaneous Dacron cuff that promotes tissue ingrowth, creating a mechanical barrier against bacterial migration along the external catheter surface. This significantly reduces the risk of catheter-related bloodstream infection compared to non-tunneled catheters, making them suitable for longer-term use.
Question 3: A nurse is preparing to access an implanted venous access port. What is the correct needle type to use?
- Standard hypodermic needle
- Butterfly needle
- Non-coring (Huber) needle (Correct answer)
- Over-the-needle catheter
Correct answer: Non-coring (Huber) needle
A non-coring (Huber) needle must be used to access an implanted port. This needle has a deflected point that parts the septum rather than coring out a piece of it. Using standard needles would remove small cores of the silicone septum with each access, eventually causing the port to leak and requiring replacement.
Question 4: What is the recommended tip position for a central venous catheter?
- Superior vena cava above the right atrium
- Cavoatrial junction or lower third of the SVC (Correct answer)
- Right atrium
- Subclavian vein
Correct answer: Cavoatrial junction or lower third of the SVC
The recommended tip position is at the cavoatrial junction (CAJ) or in the lower third of the superior vena cava. This position provides optimal blood flow around the catheter tip, reducing thrombosis risk, and ensures the tip is in a large vessel where hyperosmolar solutions are rapidly diluted. The tip should be parallel to the vessel wall.
Question 5: Which complication is most likely to occur during subclavian vein central line insertion?
- Arterial puncture
- Pneumothorax (Correct answer)
- Nerve injury
- Lymphatic duct injury
Correct answer: Pneumothorax
Pneumothorax is the most significant complication of subclavian vein catheterization due to the proximity of the lung apex to the insertion site. The risk is approximately 1-3% and is higher on the left side. A post-insertion chest X-ray is mandatory to confirm tip position and rule out pneumothorax.
Question 6: A patient with a PICC line develops arm swelling, pain, and discoloration. The nurse suspects upper extremity deep vein thrombosis. What is the priority action?
- Remove the PICC immediately
- Elevate the arm and apply warm compresses only
- Notify the provider for diagnostic ultrasound and anticoagulation evaluation (Correct answer)
- Flush the catheter with heparin
Correct answer: Notify the provider for diagnostic ultrasound and anticoagulation evaluation
Suspected upper extremity DVT requires confirmation with Doppler ultrasound and evaluation for anticoagulation therapy. The PICC should not be immediately removed unless there is clinical deterioration, as removal can dislodge thrombus. The catheter may be preserved if the patient responds to anticoagulation, avoiding the need for new venous access.
CRNI Central Venous Access Devices Practice Test 1
Which central venous access device is most appropriate for a patient requiring intermittent IV chemotherapy over 12 months?