IV Venous Access Devices 2 — Questions and Answers
Question 1: A patient has a PICC line in the left basilic vein. Before administering a vesicant, you flush with 10 mL normal saline and note resistance. What is the most appropriate next step?
- Administer the medication slowly despite resistance
- Attempt to aspirate blood return before proceeding (Correct answer)
- Remove the PICC and place a new peripheral IV
- Apply warm compress to increase flow
Correct answer: Attempt to aspirate blood return before proceeding
Confirming blood return before vesicant administration is essential; resistance without blood return suggests catheter occlusion or malposition.
Question 2: Which type of implanted port needle (Huber needle) design is used for continuous infusion to reduce coring of the septum?
- Straight non-coring needle
- Angled non-coring needle (Correct answer)
- Standard hypodermic bevel needle
- Winged infusion needle
Correct answer: Angled non-coring needle
Angled (90-degree) non-coring Huber needles are used for continuous infusions while straight non-coring needles are used for bolus injections.
Question 3: A tunneled cuffed catheter (Hickman) is preferred over a PICC for which clinical situation?
- Short-term antibiotic therapy (7–14 days)
- Long-term total parenteral nutrition over several months (Correct answer)
- Single blood draw in a difficult stick patient
- Rapid fluid resuscitation in the ED
Correct answer: Long-term total parenteral nutrition over several months
Tunneled cuffed catheters are designed for long-term venous access (months to years), making them ideal for extended TPN or chemotherapy.
Question 4: When assessing a peripheral IV site, you observe swelling, pallor, and coolness around the insertion site during an infusion. These findings are MOST consistent with:
- Phlebitis
- Infiltration (Correct answer)
- Thrombosis
- Air embolism
Correct answer: Infiltration
Swelling, pallor, and coolness at the IV site indicate infiltration, where fluid has leaked into surrounding tissue.
Question 5: Which gauge peripheral IV catheter is MOST appropriate for a patient requiring rapid blood transfusion?
- 24-gauge
- 22-gauge
- 20-gauge
- 18-gauge (Correct answer)
Correct answer: 18-gauge
An 18-gauge catheter allows adequate flow rates for blood transfusion; smaller gauges increase resistance and may cause hemolysis.
Question 6: The maximum dwell time recommended for a peripheral IV catheter in adults according to INS standards is:
- 24 hours
- 48 hours
- 72–96 hours or when clinically indicated (Correct answer)
- 7 days
Correct answer: 72–96 hours or when clinically indicated
INS standards recommend changing peripheral IVs every 72–96 hours or based on clinical assessment rather than on a strict schedule.
Question 7: A midline catheter differs from a PICC primarily in that it:
- Is inserted in the femoral vein
- Tip terminates in the axillary or subclavian vein, not the central circulation (Correct answer)
- Can be used to administer TPN without restriction
- Requires a chest X-ray for tip confirmation
Correct answer: Tip terminates in the axillary or subclavian vein, not the central circulation
A midline catheter tip resides in the axillary or basilic vein (not centrally), so it has restrictions on irritating or hyperosmolar solutions.
IV Venous Access Devices 2
A patient has a PICC line in the left basilic vein.
Before administering a vesicant, you flush with 10 mL normal saline and note resistance.
What is the most appropriate next step?