VA-BC Catheter Types 5 — Questions and Answers
Question 1: Which catheter type is MOST appropriate for a neonate requiring long-term total parenteral nutrition?
- Umbilical venous catheter for indefinite use
- Tunneled silicone CVC (e.g., Broviac) (Correct answer)
- Standard adult-sized PICC
- Non-tunneled femoral CVC
Correct answer: Tunneled silicone CVC (e.g., Broviac)
Tunneled silicone CVCs such as the Broviac are preferred for neonates requiring long-term TPN due to their small size, flexibility, and reduced infection risk.
Question 2: The Hickman catheter and Broviac catheter are both tunneled CVCs. What is the primary difference between them?
- Hickman catheters are valved; Broviac catheters are open-ended
- Hickman catheters have a larger internal lumen diameter than Broviac catheters (Correct answer)
- Broviac catheters are used only for hemodialysis
- Hickman catheters lack a Dacron cuff
Correct answer: Hickman catheters have a larger internal lumen diameter than Broviac catheters
The Hickman catheter has a larger lumen diameter than the Broviac, making it suitable for adults requiring high-volume infusions, while the Broviac's smaller lumen is used in pediatric patients.
Question 3: A patient with a peripherally inserted central catheter develops a pinch-off sign on chest X-ray. This finding indicates:
- The catheter tip has migrated into the right atrium
- The catheter is compressed between the clavicle and first rib (Correct answer)
- The catheter has developed an internal thrombus
- The insertion site has become infected
Correct answer: The catheter is compressed between the clavicle and first rib
Pinch-off sign on X-ray indicates compression of the PICC between the clavicle and first rib, which can lead to catheter fracture and embolism if not repositioned.
Question 4: Which of the following best describes the purpose of the 'cuff' on a tunneled hemodialysis catheter?
- It inflates to stabilize the catheter tip position in the SVC
- It promotes fibrous tissue ingrowth that anchors the catheter and provides an infection barrier (Correct answer)
- It is a color-coded marker identifying the venous versus arterial lumen
- It functions as a one-way valve to prevent blood backflow
Correct answer: It promotes fibrous tissue ingrowth that anchors the catheter and provides an infection barrier
The Dacron cuff on a tunneled catheter promotes fibroblast ingrowth that mechanically anchors the device and creates a biological barrier to ascending microorganisms.
Question 5: When selecting catheter lumen number for a critically ill ICU patient, the guiding principle should be:
- Always place a triple-lumen catheter to anticipate all potential needs
- Use the minimum number of lumens clinically necessary to reduce infection risk (Correct answer)
- Multi-lumen catheters are contraindicated in immunocompromised patients
- Dual-lumen catheters are preferred over single-lumen in all ICU settings
Correct answer: Use the minimum number of lumens clinically necessary to reduce infection risk
Each additional lumen increases infection risk; INS and CDC guidelines recommend using the minimum number of lumens necessary for the patient's clinical needs.
Question 6: A patient's non-coring (Huber) needle is used to access which device?
- Tunneled Hickman catheter
- Implanted venous port (Correct answer)
- PICC line
- Midline catheter
Correct answer: Implanted venous port
Huber needles are specifically designed to access implanted venous ports without coring the silicone septum, preserving its integrity for repeated use.
Question 7: Which catheter characteristic is most associated with reduced rates of catheter-related thrombosis?
- Larger outer diameter to maximize lumen size
- Polyurethane construction with a tip positioned in high-flow central venous blood (Correct answer)
- Placement in a peripheral vein to avoid central blood flow
- Use of a multi-lumen design to distribute infusate
Correct answer: Polyurethane construction with a tip positioned in high-flow central venous blood
Polyurethane catheters with tips in high-flow central veins (SVC/cavoatrial junction) reduce thrombosis risk by ensuring rapid dilution of infusates in brisk blood flow.
VA-BC Catheter Types 5
Which catheter type is MOST appropriate for a neonate requiring long-term total parenteral nutrition?