VA-BC Device Selection & Insertion Techniques 4 — Questions and Answers
Question 1: Which catheter material is associated with the LOWEST thrombogenicity for PICC lines?
- Polyvinyl chloride (PVC)
- Polyethylene
- Polyurethane or silicone (Correct answer)
- Teflon (PTFE)
Correct answer: Polyurethane or silicone
Polyurethane and silicone are the preferred materials for PICCs due to their lower thrombogenic and tissue-reactive properties.
Question 2: During PICC insertion, the patient's arm should be positioned at what angle relative to the body?
- 0 degrees (along the body)
- 45 degrees
- 90 degrees (perpendicular to body) (Correct answer)
- 120 degrees
Correct answer: 90 degrees (perpendicular to body)
Abducting the arm to 90 degrees straightens the venous pathway and facilitates PICC advancement toward the central circulation.
Question 3: A power-injectable PICC differs from a standard PICC in that it:
- Can be used for blood sampling only
- Withstands high-pressure contrast injection for CT imaging (Correct answer)
- Has a shorter dwell time
- Requires no tip confirmation by X-ray
Correct answer: Withstands high-pressure contrast injection for CT imaging
Power-injectable PICCs are rated to withstand the high injection pressures (typically 300 psi) used for CT contrast administration.
Question 4: Which factor is most important in determining catheter-to-vein ratio to reduce thrombosis risk in PICC insertion?
- Catheter length
- Patient age
- Catheter occupying no more than 45% of the vein diameter (Correct answer)
- Number of catheter lumens
Correct answer: Catheter occupying no more than 45% of the vein diameter
The catheter should occupy no more than 45% of the vein's inner diameter to maintain adequate blood flow and minimize thrombosis risk.
Question 5: An implanted port is accessed using which specialized needle?
- Standard hypodermic needle
- Huber needle (non-coring needle) (Correct answer)
- Butterfly needle
- Angiocatheter
Correct answer: Huber needle (non-coring needle)
A Huber needle has a deflected tip designed to prevent coring of the port septum, preserving septum integrity for repeated access.
Question 6: When using the modified Seldinger technique for CVAD insertion, what is the correct sequence?
- Catheter → guidewire → needle → dilator
- Needle → guidewire → dilator → catheter (Correct answer)
- Guidewire → needle → catheter → dilator
- Dilator → needle → guidewire → catheter
Correct answer: Needle → guidewire → dilator → catheter
The modified Seldinger technique involves: venipuncture with needle, guidewire insertion, dilation of the tract, then catheter advancement over the guidewire.
Question 7: Which dressing type is recommended for CVAD insertion sites per INS standards?
- Dry gauze changed every 24 hours
- Transparent semipermeable membrane (TSM) changed every 5–7 days (Correct answer)
- Hydrocolloid dressing changed weekly
- Cloth tape changed every 48 hours
Correct answer: Transparent semipermeable membrane (TSM) changed every 5–7 days
TSM dressings allow site inspection without removal and should be changed every 5–7 days or immediately if soiled, loose, or wet.
VA-BC Device Selection & Insertion Techniques 4
Which catheter material is associated with the LOWEST thrombogenicity for PICC lines?