VA-BC Maintenance and Care 3 — Questions and Answers
Question 1: Which antiseptic is preferred for central line dressing site preparation in adults who are not allergic?
- Povidone-iodine 10% solution
- Isopropyl alcohol 70% alone
- Chlorhexidine gluconate 2% with 70% isopropyl alcohol (Correct answer)
- Hydrogen peroxide 3%
Correct answer: Chlorhexidine gluconate 2% with 70% isopropyl alcohol
Chlorhexidine gluconate 2% combined with 70% isopropyl alcohol is recommended as the primary skin antiseptic for CVC insertion and dressing changes due to superior persistent antimicrobial activity.
Question 2: When should a chlorhexidine-impregnated dressing (CHG disk) be used on a CVC site?
- For all patients with any type of central venous access device
- For patients whose catheter site cannot be covered with a standard dressing
- When the CLABSI rate remains above goal despite standard practices (Correct answer)
- Only for patients who are immunocompromised
Correct answer: When the CLABSI rate remains above goal despite standard practices
CDC and INS guidelines support CHG-impregnated dressings as an additional measure when CLABSI rates remain elevated despite implementation of standard prevention bundles.
Question 3: A patient with a non-tunneled CVC develops redness, warmth, and purulent drainage at the insertion site. Which step should be taken FIRST?
- Apply topical antibiotic ointment and change the dressing
- Notify the provider and obtain site cultures before removing the catheter (Correct answer)
- Immediately remove the catheter and send the tip for culture
- Increase the frequency of dressing changes to every 24 hours
Correct answer: Notify the provider and obtain site cultures before removing the catheter
The provider must be notified and cultures obtained before catheter removal so appropriate decision-making regarding salvage versus removal can be made.
Question 4: What is the correct order of steps when using a needleless connector prior to medication administration?
- Scrub the hub for 5-15 seconds, allow to dry, then access (Correct answer)
- Access immediately after wiping with an alcohol swab
- Apply CHG solution and access after 30 seconds
- Wipe once with povidone-iodine and access right away
Correct answer: Scrub the hub for 5-15 seconds, allow to dry, then access
Scrubbing the needleless connector for 5-15 seconds with alcohol or CHG and allowing it to dry before access ('scrub the hub') reduces microbial contamination.
Question 5: An implanted port that is not in active use should be accessed and flushed at which interval to maintain patency?
- Every 24 hours
- Every 7 days
- Every 4 weeks
- Every 3 months (Correct answer)
Correct answer: Every 3 months
INS standards recommend flushing implanted ports every 3 months when not in use to maintain patency and prevent occlusion.
Question 6: Which patient position is safest when removing a non-tunneled subclavian CVC?
- High Fowler's with legs dangling
- Semi-recumbent with head of bed elevated 45 degrees
- Supine or slight Trendelenburg with the patient exhaling or performing Valsalva (Correct answer)
- Lateral decubitus on the affected side
Correct answer: Supine or slight Trendelenburg with the patient exhaling or performing Valsalva
Supine or Trendelenburg positioning during exhalation or Valsalva raises intrathoracic pressure and prevents air embolism during CVC removal.
Question 7: After removing a CVC, pressure should be held and the site should be covered with which type of dressing?
- Wet gauze secured with tape until bleeding stops
- Occlusive petroleum-based gauze dressing for at least 24 hours (Correct answer)
- Transparent semipermeable membrane applied immediately after removal
- Dry sterile gauze changed every 8 hours for 48 hours
Correct answer: Occlusive petroleum-based gauze dressing for at least 24 hours
An occlusive petroleum-based gauze dressing applied for at least 24 hours prevents air from entering the exit wound tract and reduces air embolism risk post-removal.
VA-BC Maintenance and Care 3
Which antiseptic is preferred for central line dressing site preparation in adults who are not allergic?