VA-BC Maintenance and Care 4 — Questions and Answers
Question 1: A hemodialysis catheter is to be used for blood draws. Which practice is recommended to minimize infection risk?
- Draw blood from the catheter without additional disinfection if the cap was recently changed
- Use strict aseptic technique with mask, sterile gloves, and hub disinfection before each access (Correct answer)
- Wipe the hub with an alcohol swab for 2 seconds before each access
- Reserve blood draws to once per shift to limit hub manipulation
Correct answer: Use strict aseptic technique with mask, sterile gloves, and hub disinfection before each access
Hemodialysis catheters require maximum barrier precautions including mask and sterile gloves and thorough hub disinfection before every access due to high CRBSI risk.
Question 2: Which finding is most consistent with catheter-associated thrombosis in a patient with an upper extremity PICC?
- Localized redness limited to the skin directly over the insertion site
- Unilateral arm swelling, pain, and erythema extending from the insertion site distally (Correct answer)
- Decreased urine output and hyponatremia
- Bilateral pedal edema and shortness of breath
Correct answer: Unilateral arm swelling, pain, and erythema extending from the insertion site distally
Unilateral arm swelling, pain, and erythema extending from the PICC site are classic signs of upper extremity deep vein thrombosis associated with the catheter.
Question 3: What is the recommended approach when instilling alteplase (tPA) to treat a completely occluded PICC?
- Infuse alteplase at 0.5 mg/hr continuously until the occlusion resolves
- Instill 2 mg/2 mL of alteplase, dwell for up to 120 minutes, then attempt aspiration (Correct answer)
- Flush forcefully with 20 mL normal saline to mechanically clear the occlusion first
- Use a 1 mL syringe to inject alteplase under high pressure
Correct answer: Instill 2 mg/2 mL of alteplase, dwell for up to 120 minutes, then attempt aspiration
Instilling 2 mg/2 mL alteplase and allowing a dwell time of up to 120 minutes is the standard protocol for thrombolytic clearance of a completely occluded PICC.
Question 4: A patient's PICC dressing is due for a change but the patient is in isolation for C. difficile. What PPE is required for the dressing change?
- Standard precautions only (gloves and gown)
- Contact precautions (gown and gloves) in addition to the standard maximal barrier precautions for the dressing change (Correct answer)
- Airborne precautions with N95 respirator, gown, and gloves
- No additional PPE beyond a surgical mask and clean gloves
Correct answer: Contact precautions (gown and gloves) in addition to the standard maximal barrier precautions for the dressing change
Contact isolation precautions must be layered on top of standard dressing change technique, requiring a gown and gloves throughout the procedure.
Question 5: Which type of IV administration tubing must be changed every 24 hours regardless of other factors?
- Tubing used for continuous normal saline infusions
- Tubing used for lipid-containing parenteral nutrition or propofol infusions (Correct answer)
- Primary tubing for intermittent antibiotic infusions
- Secondary tubing for piggyback medications
Correct answer: Tubing used for lipid-containing parenteral nutrition or propofol infusions
Tubing used for lipid-containing solutions (TPN with fat emulsions) and propofol must be changed every 24 hours due to the risk of microbial growth in lipid media.
Question 6: When performing a PICC dressing change, the nurse should assess the external catheter length and compare it to the documented baseline length. Why is this important?
- To determine if additional catheter length needs to be inserted
- To detect catheter migration, which can lead to malposition and complications (Correct answer)
- To calculate how much flush solution is needed
- To verify that the correct dressing size should be used
Correct answer: To detect catheter migration, which can lead to malposition and complications
Comparing the external catheter length at each dressing change to the baseline detects migration, which can cause malposition, arrhythmias, or extravasation.
Question 7: A tunneled Hickman catheter develops a crack in the external portion of the catheter. What is the most appropriate immediate action?
- Clamp the catheter proximal to the crack, apply a sterile dressing, and notify the provider (Correct answer)
- Remove the catheter immediately at the bedside
- Flush the catheter with saline to test if it is still functional
- Apply surgical tape over the crack and continue use until a repair kit is available
Correct answer: Clamp the catheter proximal to the crack, apply a sterile dressing, and notify the provider
Clamping proximal to a crack prevents blood loss and air embolism while a provider is notified to arrange catheter repair or replacement.
VA-BC Maintenance and Care 4
A hemodialysis catheter is to be used for blood draws.
Which practice is recommended to minimize infection risk?