VA-BC Documentation 3 — Questions and Answers
Question 1: Before inserting a PICC in a competent adult patient, which documentation must be completed FIRST?
- Signed informed consent including risks, benefits, and alternatives (Correct answer)
- Post-procedure tip confirmation note
- The nursing care plan update
- An allergy list verification only
Correct answer: Signed informed consent including risks, benefits, and alternatives
Informed consent must be obtained and documented before any invasive procedure, including PICC insertion, to uphold patient autonomy and legal standards.
Question 2: Which timeframe is most commonly required by regulatory standards for completing procedure documentation after PICC insertion?
- Before the patient leaves the procedure area or within the same shift (Correct answer)
- Within 72 hours of the procedure
- At the end of the nursing week
- Only when the patient is discharged
Correct answer: Before the patient leaves the procedure area or within the same shift
Most accrediting bodies and institutional policies require procedure notes to be completed before the patient leaves or promptly within the same shift to ensure accuracy.
Question 3: A patient develops a suspected catheter-related bloodstream infection (CRBSI). Which documentation action is MOST important to initiate immediately?
- Document symptom onset time, cultures obtained, catheter characteristics, and notification of the physician (Correct answer)
- Remove the catheter and document removal only
- Wait for culture results before documenting suspicion
- Document the event only in the incident report system
Correct answer: Document symptom onset time, cultures obtained, catheter characteristics, and notification of the physician
Immediate documentation of clinical findings, specimens collected, and provider notification creates a timeline critical for infection tracking and CLABSI surveillance.
Question 4: Central line bundle compliance requires documentation of which element at EVERY dressing change?
- Daily necessity review and whether the line is still required (Correct answer)
- The nurse's personal assessment of line placement
- Patient satisfaction with the dressing
- Only the date of the dressing change
Correct answer: Daily necessity review and whether the line is still required
Central line bundles include daily review of line necessity; documenting this decision is required to support early removal and reduce CLABSI risk.
Question 5: When documenting a catheter flush using the SASH protocol, which detail is LEAST acceptable to omit?
- Volume and type of solution used for each flush step (Correct answer)
- The nurse's shift assignment
- Whether the patient verbalized comfort
- The color of the flush syringe cap
Correct answer: Volume and type of solution used for each flush step
SASH documentation requires recording each solution type and volume (saline, antibiotic lock if applicable, saline, heparin) to verify protocol adherence and detect errors.
Question 6: When a central venous catheter is removed, which finding must be included in the documentation to confirm complete removal?
- Catheter length intact, tip intact, and hemostasis achieved at the site (Correct answer)
- Patient's verbal report of comfort only
- The name of the staff member who disposed of the catheter
- Only the time of removal
Correct answer: Catheter length intact, tip intact, and hemostasis achieved at the site
Documenting that the entire catheter was removed intact, including tip integrity, and that hemostasis was achieved is essential to rule out catheter fracture or embolism.
Question 7: During a routine vascular access site assessment, the nurse notes no blood return from a PICC. How should this finding be documented?
- Absence of blood return noted, flush resistance assessed, troubleshooting steps taken, and clinician notified if unresolved (Correct answer)
- Simply write 'PICC flushed without difficulty'
- Omit the finding if the line flushes freely
- Document only after blood return is restored
Correct answer: Absence of blood return noted, flush resistance assessed, troubleshooting steps taken, and clinician notified if unresolved
Absence of blood return is a clinical finding that must be documented along with troubleshooting actions, as it may indicate catheter malposition, thrombosis, or fibrin sheath formation.
VA-BC Documentation 3
Before inserting a PICC in a competent adult patient, which documentation must be completed FIRST?