VA-BC Maintenance and Care 2 — Questions and Answers
Question 1: When assessing a central venous catheter (CVC) dressing, which finding requires immediate intervention?
- Dressing applied 48 hours ago that is intact and dry
- Visible moisture or drainage under a transparent semipermeable membrane dressing (Correct answer)
- Slight tan discoloration of tape edges
- Date and time written on the dressing label
Correct answer: Visible moisture or drainage under a transparent semipermeable membrane dressing
Moisture or drainage under a TSM dressing compromises the sterile barrier and requires immediate dressing change to prevent infection.
Question 2: What is the recommended technique for flushing a peripheral IV catheter to maintain patency?
- Rapid bolus injection of normal saline
- Pulsatile push-pause technique with normal saline (Correct answer)
- Continuous slow drip of heparin solution
- Gravity-assisted flush using a 60 mL syringe
Correct answer: Pulsatile push-pause technique with normal saline
The pulsatile push-pause technique creates turbulence that removes fibrin and debris from the catheter lumen, maintaining patency.
Question 3: A patient's PICC line has a positive blood culture for Candida albicans. What is the most appropriate next step?
- Change the dressing and continue using the line with antifungal lock therapy
- Remove the PICC line immediately and obtain peripheral cultures (Correct answer)
- Administer antifungal medication through the line and reassess in 72 hours
- Replace the PICC line over a guidewire
Correct answer: Remove the PICC line immediately and obtain peripheral cultures
Fungal catheter-related bloodstream infections require prompt catheter removal, as salvage is rarely successful and carries high morbidity.
Question 4: Which action best prevents air embolism during PICC dressing changes?
- Having the patient perform the Valsalva maneuver or placing them in Trendelenburg position (Correct answer)
- Keeping the patient in high Fowler's position throughout the procedure
- Clamping the line only after the dressing is fully removed
- Flushing 20 mL of saline before removing the old dressing
Correct answer: Having the patient perform the Valsalva maneuver or placing them in Trendelenburg position
Valsalva maneuver or Trendelenburg positioning increases intrathoracic pressure, reducing the risk of air entering the catheter during dressing changes.
Question 5: How often should needleless connector caps on a central venous catheter be changed according to INS standards?
- Every 24 hours regardless of use
- No more frequently than every 96 hours and with each new IV tubing set change (Correct answer)
- Every 7 days or when visibly soiled
- Only when blood is aspirated through the connector
Correct answer: No more frequently than every 96 hours and with each new IV tubing set change
INS standards recommend changing needleless connectors no more frequently than every 96 hours and in conjunction with IV administration set changes.
Question 6: What is the primary purpose of using a 10 mL or larger syringe when flushing a PICC line?
- To deliver a larger volume of flush solution
- To limit the pressure generated and prevent catheter damage (Correct answer)
- To ensure faster medication delivery
- To reduce the risk of air embolism
Correct answer: To limit the pressure generated and prevent catheter damage
Smaller syringes generate higher pressure per unit of force applied; a 10 mL syringe keeps pressure within safe limits to avoid catheter rupture.
Question 7: A nurse notes that blood cannot be aspirated from a PICC but the line flushes without resistance. What is the most likely cause?
- Catheter occlusion by a thrombus
- Fibrin sheath or fibrin tail at the catheter tip (Correct answer)
- Catheter tip migration into the jugular vein
- Air lock in the catheter lumen
Correct answer: Fibrin sheath or fibrin tail at the catheter tip
A fibrin sheath acts as a one-way valve, allowing fluid to infuse but preventing blood aspiration.
VA-BC Maintenance and Care 2
When assessing a central venous catheter (CVC) dressing, which finding requires immediate intervention?