CRNI Vascular Access Device Management 4 — Questions and Answers
Question 1: A patient with a PICC line develops a fever of 38.9°C and chills during an infusion. What is the priority nursing action?
- Slow the infusion rate and monitor
- Stop the infusion and notify the provider immediately (Correct answer)
- Administer antipyretics and continue the infusion
- Flush the PICC line with normal saline
Correct answer: Stop the infusion and notify the provider immediately
Fever and chills during infusion through a central vascular access device suggest catheter-related bloodstream infection (CRBSI), requiring immediate cessation of infusion and provider notification.
Question 2: Which technique is used to remove air from IV tubing before connecting to a central venous catheter?
- Purging the line by allowing fluid to flow through until air-free (Correct answer)
- Aspirating air with a syringe after connection
- Clamping the tubing and proceeding with connection
- Inverting the IV bag to displace air
Correct answer: Purging the line by allowing fluid to flow through until air-free
Priming (purging) the IV tubing before connection removes air and prevents air embolism, a serious complication of central venous catheter use.
Question 3: A nurse is caring for a patient with an implanted port. Which needle type must be used to access an implanted port?
- Standard hypodermic needle
- Non-coring (Huber) needle (Correct answer)
- Butterfly needle
- Spinal needle
Correct answer: Non-coring (Huber) needle
Non-coring (Huber) needles have an angled bevel that displaces the port septum without cutting it, preserving septum integrity for repeated access.
Question 4: When assessing a peripheral IV site, which finding requires immediate catheter removal?
- Mild redness extending 2 cm from the insertion site (Correct answer)
- Sluggish flow rate requiring repositioning
- Slight discomfort when flushing
- Cool skin adjacent to the insertion site
Correct answer: Mild redness extending 2 cm from the insertion site
Redness extending 2 cm from the insertion site indicates phlebitis (Grade 2 or higher), which requires catheter removal per INS standards.
Question 5: A tunneled central venous catheter has a dacron cuff. What is the primary purpose of this cuff?
- To secure the catheter to the skin during insertion
- To act as a bacterial barrier and anchor the catheter subcutaneously (Correct answer)
- To reduce thrombosis at the catheter tip
- To facilitate blood sampling without contamination
Correct answer: To act as a bacterial barrier and anchor the catheter subcutaneously
The dacron cuff promotes fibrous tissue ingrowth, anchoring the tunneled catheter subcutaneously and providing a mechanical barrier against bacterial migration.
Question 6: Which catheter-to-vein ratio is recommended to minimize thrombosis risk when placing a PICC line?
- The catheter should occupy no more than 45% of the vein lumen (Correct answer)
- The catheter should fill at least 60% of the vein lumen
- The catheter diameter should equal the vein diameter
- No specific ratio exists; any size is acceptable
Correct answer: The catheter should occupy no more than 45% of the vein lumen
INS guidelines recommend a catheter-to-vein ratio of ≤45% to allow adequate blood flow around the catheter and reduce thrombosis risk.
Question 7: When discontinuing a PICC line, what position should the patient be placed in, and why?
- Trendelenburg position to reduce risk of air embolism (Correct answer)
- High Fowler's position to facilitate catheter removal
- Lateral decubitus to prevent bleeding
- Supine with the arm elevated to reduce venous pressure
Correct answer: Trendelenburg position to reduce risk of air embolism
Trendelenburg (or supine with Valsalva) positioning increases intrathoracic pressure and reduces the risk of air embolism during PICC removal.
CRNI Vascular Access Device Management 4
A patient with a PICC line develops a fever of 38.9°C and chills during an infusion.
What is the priority nursing action?