VA-BC Patient Evaluation & Care Coordination 3 — Questions and Answers
Question 1: A patient with stage 3 chronic kidney disease (CKD) requires IV antibiotics for 6 weeks. Which vascular access device best preserves future vascular access for potential dialysis?
- Peripheral IV catheter with weekly rotation
- PICC line in the antecubital fossa
- Tunneled central venous catheter via internal jugular vein (Correct answer)
- Midline catheter in the basilic vein
Correct answer: Tunneled central venous catheter via internal jugular vein
In CKD patients, preserving arm veins for future AV fistula creation is critical; a tunneled CVC via the jugular vein avoids upper extremity vein damage while providing reliable long-term access.
Question 2: During care coordination rounds, the team asks the vascular access nurse to recommend an access device for a patient requiring daily labs and intermittent IV medications for an expected 10-day hospitalization. The best recommendation is:
- Implanted port
- PICC line
- Peripheral IV catheter changed every 72-96 hours per policy (Correct answer)
- Tunneled hemodialysis catheter
Correct answer: Peripheral IV catheter changed every 72-96 hours per policy
For a 10-day hospitalization with intermittent needs, a peripheral IV rotated per policy is the least invasive, most appropriate device; PICC lines are not indicated for short inpatient stays alone.
Question 3: Which patient factor most increases the risk of catheter-related bloodstream infection (CRBSI) and should be identified during pre-insertion assessment?
- Age over 65 years
- Active immunosuppression or neutropenia (Correct answer)
- Female sex
- Right-sided catheter placement
Correct answer: Active immunosuppression or neutropenia
Immunosuppression and neutropenia impair the patient's ability to fight infection, significantly increasing CRBSI risk and necessitating enhanced prevention strategies.
Question 4: A vascular access nurse receives an order for a PICC in a patient with a platelet count of 18,000/μL. What is the most appropriate action?
- Proceed with PICC insertion using standard technique
- Place the PICC using a smaller gauge needle to minimize bleeding
- Contact the ordering provider to discuss thrombocytopenia and obtain platelet transfusion or alternative access plan (Correct answer)
- Cancel the order and place a peripheral IV instead
Correct answer: Contact the ordering provider to discuss thrombocytopenia and obtain platelet transfusion or alternative access plan
Severe thrombocytopenia (platelet count <50,000/μL) significantly increases bleeding risk with PICC insertion; the nurse should communicate this to the provider and collaborate on a safe insertion plan, which may include platelet transfusion.
Question 5: When evaluating a patient for an implanted port, which physical assessment finding would be a contraindication to port placement in the chest?
- History of hypertension
- Pacemaker or ICD leads on the ipsilateral side (Correct answer)
- BMI of 28
- Age over 70 years
Correct answer: Pacemaker or ICD leads on the ipsilateral side
Pacemaker or ICD leads on the same side as the planned port create a risk of lead displacement during subclavian/cephalic vein access and complicate port placement.
Question 6: A home infusion patient calls reporting redness, warmth, and pain along the vein proximal to their midline catheter insertion site. The nurse should first:
- Instruct the patient to apply a cold compress and monitor for 24 hours
- Advise the patient to flush the catheter more vigorously
- Instruct the patient to stop the infusion and arrange immediate evaluation for superficial thrombophlebitis (Correct answer)
- Recommend over-the-counter antihistamines for the reaction
Correct answer: Instruct the patient to stop the infusion and arrange immediate evaluation for superficial thrombophlebitis
Signs of superficial thrombophlebitis—redness, warmth, and pain along the vein tract—require immediate cessation of the infusion and prompt clinical evaluation for possible device removal.
Question 7: Which element of a structured pre-insertion assessment directly informs the nurse's decision on catheter tip location?
- Patient's hand dominance
- Measurement of external arm length from insertion site to the sternal notch to right third intercostal space (Correct answer)
- Patient's most recent CBC results
- Type of dressing the patient prefers
Correct answer: Measurement of external arm length from insertion site to the sternal notch to right third intercostal space
Arm measurement from the insertion site to the sternal notch and then to the right third intercostal space estimates catheter length needed to achieve optimal tip position at the cavoatrial junction.
VA-BC Patient Evaluation & Care Coordination 3
A patient with stage 3 chronic kidney disease (CKD) requires IV antibiotics for 6 weeks.
Which vascular access device best preserves future vascular access for potential dialysis?