VA-BC Device Selection & Insertion Techniques 5 — Questions and Answers
Question 1: A patient needs TPN with an osmolarity of 1,500 mOsm/L. Which access device is appropriate?
- Peripheral IV catheter
- Midline catheter
- Central venous access device (Correct answer)
- Arterial line
Correct answer: Central venous access device
Solutions exceeding 900 mOsm/L must be administered through a central venous access device to prevent peripheral vein damage.
Question 2: Intraosseous (IO) access is most appropriate in which situation?
- Elective outpatient chemotherapy
- Emergency when IV access cannot be rapidly established (Correct answer)
- Long-term antibiotic therapy
- Routine blood sampling in adults
Correct answer: Emergency when IV access cannot be rapidly established
IO access provides rapid vascular access to the bone marrow cavity during emergencies when conventional IV access fails.
Question 3: Which of the following is a contraindication to basilic vein PICC insertion?
- Intact skin at the antecubital fossa
- History of DVT in the ipsilateral upper extremity (Correct answer)
- Need for long-term antibiotics
- Difficult peripheral IV access
Correct answer: History of DVT in the ipsilateral upper extremity
Previous DVT in the ipsilateral extremity contraindicates PICC insertion in that arm due to high risk of rethrombosis and vessel compromise.
Question 4: What is the recommended maximum dwell time for a peripheral IV catheter in adults, absent complications?
- 24 hours
- 48 hours
- 72–96 hours (Correct answer)
- 7 days
Correct answer: 72–96 hours
CDC guidelines recommend rotating peripheral IV sites every 72–96 hours in adults unless clinical indication requires earlier removal.
Question 5: During ultrasound-guided PICC insertion, the 'dynamic needle tip positioning' (DNTP) technique aims to:
- Monitor catheter tip ECG signal
- Continuously visualize the needle tip throughout vessel entry (Correct answer)
- Measure vein diameter in real time
- Confirm tip position at the cavoatrial junction
Correct answer: Continuously visualize the needle tip throughout vessel entry
DNTP keeps the needle tip continuously in view on ultrasound during advancement, reducing risk of posterior wall puncture.
Question 6: Which catheter stabilization method is preferred per INS guidelines to reduce CVAD-related complications?
- Sutures at the insertion site
- Tape butterflies over the hub
- Engineered stabilization device (ESD) (Correct answer)
- Transparent dressing alone
Correct answer: Engineered stabilization device (ESD)
Engineered stabilization devices (ESDs) are preferred over sutures or tape as they reduce movement, dislodgement, and infection risk.
Question 7: A nurse notices resistance when attempting to flush a PICC line. The FIRST action should be:
- Apply forceful pressure to clear the obstruction
- Assess for catheter kinking, positional changes, or clamp engagement (Correct answer)
- Immediately remove the PICC
- Instill a thrombolytic agent
Correct answer: Assess for catheter kinking, positional changes, or clamp engagement
Resistance to flushing should first prompt assessment for mechanical causes (kinking, clamp, positional issues) before assuming occlusion.
VA-BC Device Selection & Insertion Techniques 5
A patient needs TPN with an osmolarity of 1,500 mOsm/L.
Which access device is appropriate?