VA-BC Pediatric Access 4 — Questions and Answers
Question 1: Which catheter-to-vein ratio is recommended to minimize thrombotic risk when selecting a PICC for a pediatric patient?
- Catheter should occupy no more than 45% of the vein lumen
- Catheter should occupy no more than 33% of the vein lumen (Correct answer)
- Catheter should occupy no more than 70% of the vein lumen
- Catheter diameter is irrelevant in pediatric patients
Correct answer: Catheter should occupy no more than 33% of the vein lumen
INS and AVA guidelines recommend the catheter occupy no more than 33% of the vein lumen to maintain adequate blood flow and reduce thrombosis risk.
Question 2: A neonate receiving parenteral nutrition (PN) through a peripheral IV develops erythema, blistering, and skin breakdown at the site. This is MOST consistent with:
- Phlebitis grade 1
- Extravasation with tissue necrosis risk (Correct answer)
- Allergic reaction to the IV catheter material
- Normal flushing response
Correct answer: Extravasation with tissue necrosis risk
Blistering and skin breakdown following PN infusion indicate extravasation, which is a medical emergency in neonates due to high osmolarity causing tissue necrosis.
Question 3: When teaching a parent to care for their child's peripherally inserted central catheter (PICC) at home, the nurse should instruct them to report which symptom IMMEDIATELY?
- Mild itching around the dressing that resolves with repositioning
- Fever greater than 38°C (100.4°F) (Correct answer)
- Slight redness from tape adhesive
- Minor clear drainage under the dressing on day 1
Correct answer: Fever greater than 38°C (100.4°F)
Fever greater than 38°C in a child with a PICC may indicate catheter-related bloodstream infection and requires immediate medical evaluation.
Question 4: In premature neonates, which anatomical factor makes scalp veins an acceptable but secondary peripheral IV site?
- Scalp veins have larger diameters than extremity veins in this population
- Scalp veins are well-visualized and relatively immobile, aiding cannulation (Correct answer)
- Scalp veins carry less infection risk than extremity sites
- Scalp veins are preferred because neonates move their heads less than limbs
Correct answer: Scalp veins are well-visualized and relatively immobile, aiding cannulation
Scalp veins are visible and relatively fixed against the skull, making them easier to cannulate in premature neonates when extremity veins are inaccessible.
Question 5: Which osmolarity threshold for IV solutions generally requires central venous access rather than peripheral access in pediatric patients?
- Greater than 300 mOsm/L
- Greater than 500 mOsm/L
- Greater than 900 mOsm/L (Correct answer)
- Greater than 1200 mOsm/L
Correct answer: Greater than 900 mOsm/L
Solutions with osmolarity greater than 900 mOsm/L are typically required to be administered through central venous access to prevent peripheral vein damage.
Question 6: A nurse uses ultrasound guidance for peripheral IV placement in a 7-year-old with difficult access. In the transverse (short-axis) view, the vein appears as:
- An elongated tubular structure running along the screen
- A pulsating bright oval structure
- A circular dark (anechoic) structure that compresses with pressure (Correct answer)
- A hyperechoic (bright white) circular structure
Correct answer: A circular dark (anechoic) structure that compresses with pressure
In the transverse ultrasound view, veins appear as circular, anechoic (dark) structures that collapse easily with probe pressure, distinguishing them from arteries.
Question 7: Following IO insertion in a pediatric patient, the nurse should confirm correct placement by which finding?
- The needle stands upright without support and bone marrow can be aspirated (Correct answer)
- The child reports decreased pain at the site after placement
- Blood return is seen in the IV tubing within 30 seconds
- A soft tissue bulge appears distal to the insertion site
Correct answer: The needle stands upright without support and bone marrow can be aspirated
Correct IO placement is confirmed when the needle stands upright without support and bone marrow aspirate is obtained, confirming intramedullary position.
VA-BC Pediatric Access 4
Which catheter-to-vein ratio is recommended to minimize thrombotic risk when selecting a PICC for a pediatric patient?