VA-BC Infection Prevention & Complication Management 4 — Questions and Answers
Question 1: A nurse is unable to flush a PICC line and notes resistance. Which action should be performed FIRST?
- Apply forceful pressure with a 10 mL syringe
- Reposition the patient's arm and ask them to cough or breathe deeply (Correct answer)
- Obtain a chest X-ray to confirm tip position
- Instill alteplase (tPA) immediately
Correct answer: Reposition the patient's arm and ask them to cough or breathe deeply
Positional occlusion (catheter tip against vessel wall) is common; repositioning the arm, changing patient position, or having the patient cough often restores patency before further intervention.
Question 2: When administering alteplase (tPA) for a thrombotic catheter occlusion, what is the standard dwell time recommended before attempting aspiration?
- 5–10 minutes
- 30 minutes
- 30–120 minutes (Correct answer)
- 4–6 hours
Correct answer: 30–120 minutes
Standard protocols recommend a dwell time of 30–120 minutes (commonly 30 minutes with a repeat dwell if needed) to allow alteplase to dissolve the fibrin clot.
Question 3: A patient with an implanted port is noted to have difficulty withdrawing blood but infusion flows freely. This is MOST likely due to:
- Catheter tip malposition
- Fibrin tail or fibrin sheath formation (Correct answer)
- Complete thrombotic occlusion
- Pinch-off syndrome
Correct answer: Fibrin tail or fibrin sheath formation
A fibrin tail or sheath acts as a one-way valve allowing infusion but obstructing aspiration, which is a hallmark presentation distinguishing it from complete thrombotic occlusion.
Question 4: Which of the following is considered an ABSOLUTE indication for immediate central venous catheter removal?
- Phlebitis grade 2 at the exit site
- Positive blood culture for Candida species (Correct answer)
- Asymptomatic catheter-associated thrombosis
- Elevated CRP without fever or positive culture
Correct answer: Positive blood culture for Candida species
Fungal CRBSI (e.g., Candida) mandates immediate catheter removal because the risk of biofilm-protected yeast causing persistent or metastatic infection is extremely high.
Question 5: A patient receiving vesicant chemotherapy via a peripheral IV reports burning pain and the nurse observes blanching at the site. What is the IMMEDIATE priority action?
- Aspirate through the IV catheter then remove it
- Stop the infusion, disconnect the IV tubing, and attempt aspiration before removing the catheter (Correct answer)
- Apply ice to the site and slow the infusion rate
- Flush the site with normal saline and elevate the extremity
Correct answer: Stop the infusion, disconnect the IV tubing, and attempt aspiration before removing the catheter
For vesicant extravasation, stop infusion immediately, leave the catheter in place, disconnect tubing, and aspirate as much residual drug as possible before removal to minimize tissue damage.
Question 6: Which of the following is the MOST effective method to prevent needleless connector contamination during routine line maintenance?
- Replacing connectors with every dressing change
- Vigorous mechanical scrub of the connector surface for ≥5 seconds with CHG/alcohol prior to each access (Correct answer)
- Keeping a sterile cap on the connector at all times between uses
- Changing connectors every 24 hours on lipid-based infusions
Correct answer: Vigorous mechanical scrub of the connector surface for ≥5 seconds with CHG/alcohol prior to each access
Vigorous mechanical scrub ('scrub the hub') with CHG/alcohol disinfectant for ≥5 seconds followed by drying is the standard practice to decontaminate needleless connectors before access.
Question 7: A nurse observes swelling at the neck and reports the patient is coughing during central line placement. This finding is MOST consistent with which complication?
- Catheter tip malposition
- Pneumothorax (Correct answer)
- Arterial puncture
- Air embolism
Correct answer: Pneumothorax
Coughing during central line insertion, particularly subclavian or internal jugular placement, combined with neck swelling or respiratory distress, suggests pneumothorax from pleural puncture.
VA-BC Infection Prevention & Complication Management 4
A nurse is unable to flush a PICC line and notes resistance.
Which action should be performed FIRST?