VA-BC Patient Evaluation & Care Coordination 2 — Questions and Answers
Question 1: A patient with a history of bilateral mastectomy requires IV access. What is the most appropriate initial action when selecting a vascular access site?
- Insert a PICC in the antecubital fossa of the dominant arm
- Consult with the physician regarding alternative access options given lymphedema risk bilaterally (Correct answer)
- Insert a peripheral IV in the foot to avoid upper extremity complications
- Place a midline catheter in the neck
Correct answer: Consult with the physician regarding alternative access options given lymphedema risk bilaterally
Bilateral mastectomy creates bilateral lymphedema risk, making standard upper extremity access contraindicated without physician consultation and potentially requiring central venous access or lower extremity alternatives.
Question 2: During the initial patient assessment for vascular access, which finding would most significantly influence the choice between a PICC and a tunneled central venous catheter?
- Patient preference for minimal dressing changes
- Anticipated therapy duration exceeding 3 months with frequent blood draws (Correct answer)
- Patient allergy to chlorhexidine
- Need for a single-lumen device
Correct answer: Anticipated therapy duration exceeding 3 months with frequent blood draws
Therapy duration exceeding 3 months with frequent blood draws favors a tunneled CVC for its longevity, durability, and lower infection risk over extended periods compared to PICC lines.
Question 3: A vascular access nurse is coordinating care for a patient transitioning from hospital to home IV therapy. Which action is the highest priority before discharge?
- Scheduling the first outpatient follow-up appointment
- Confirming the home health agency can support the prescribed infusion therapy and device type (Correct answer)
- Removing the current access device and replacing it with a new one
- Notifying the insurance company of the device placed
Correct answer: Confirming the home health agency can support the prescribed infusion therapy and device type
Confirming the home health agency's capability to manage the specific device and therapy prevents care gaps and ensures safe continuation of treatment after discharge.
Question 4: Which assessment finding is a contraindication to placing a subclavian vein PICC?
- Patient BMI of 32
- INR of 1.5
- Ipsilateral subclavian vein thrombosis (Correct answer)
- Serum creatinine of 1.2 mg/dL
Correct answer: Ipsilateral subclavian vein thrombosis
Ipsilateral subclavian vein thrombosis obstructs the pathway for PICC advancement and increases the risk of propagating the thrombus, making it a direct contraindication.
Question 5: A nurse is evaluating a patient for vascular access and notes the patient's veins are difficult to visualize or palpate. What is the recommended next step according to current evidence-based guidelines?
- Attempt three venipunctures before requesting assistance
- Use ultrasound guidance to assess and cannulate peripheral veins (Correct answer)
- Immediately place a central venous catheter
- Apply a tourniquet for 5 minutes to engorge the veins before attempting access
Correct answer: Use ultrasound guidance to assess and cannulate peripheral veins
Current INS and AVA guidelines recommend ultrasound guidance for patients with difficult venous access to improve first-attempt success and reduce complications.
Question 6: When performing a pre-insertion assessment for a PICC, a nurse measures the patient's arm circumference at 10 cm above the antecubital fossa. This measurement is primarily used for:
- Determining the appropriate catheter gauge
- Establishing a baseline to monitor for deep vein thrombosis post-insertion (Correct answer)
- Calculating the required catheter insertion length
- Selecting the appropriate dressing size
Correct answer: Establishing a baseline to monitor for deep vein thrombosis post-insertion
Baseline arm circumference measurement before PICC insertion allows post-insertion comparison to detect swelling indicative of DVT development.
Question 7: A patient receiving chemotherapy via a PICC develops arm swelling and pain 10 days post-insertion. Which is the priority nursing intervention?
- Increase the flush frequency of the catheter
- Apply a warm compress and elevate the arm
- Discontinue infusion and notify the provider; assess for PICC-related DVT (Correct answer)
- Reposition the PICC and obtain a chest X-ray
Correct answer: Discontinue infusion and notify the provider; assess for PICC-related DVT
Arm swelling and pain after PICC insertion are cardinal signs of PICC-related DVT; the priority is to stop the infusion, assess the patient, and notify the provider for diagnostic imaging.
VA-BC Patient Evaluation & Care Coordination 2
A patient with a history of bilateral mastectomy requires IV access.
What is the most appropriate initial action when selecting a vascular access site?