VA-BC Pediatric Access 5 — Questions and Answers
Question 1: A 5-year-old with sickle cell disease requires frequent IV access. Which vascular access strategy is MOST appropriate for long-term management?
- Rotating peripheral IV sites every 24 hours indefinitely
- Implanted venous port to preserve peripheral veins (Correct answer)
- Daily PICC line placements
- Femoral central line as first choice
Correct answer: Implanted venous port to preserve peripheral veins
An implanted venous port is preferred for patients with sickle cell disease requiring frequent IV access because it preserves peripheral veins and reduces infection risk with proper care.
Question 2: When performing a dressing change on a pediatric PICC, the nurse notes the exit site has a small amount of dried blood and no redness. The MOST appropriate action is:
- Remove and replace the PICC immediately due to bleeding
- Cleanse with chlorhexidine gluconate, apply a new dressing, and document (Correct answer)
- Apply antibiotic ointment to the site before re-dressing
- Leave the old dressing in place and reassess in 24 hours
Correct answer: Cleanse with chlorhexidine gluconate, apply a new dressing, and document
Dried blood at a PICC exit site without signs of infection is a normal finding; the site should be cleansed with chlorhexidine, redressed, and documented.
Question 3: A 14-year-old athlete is hospitalized and requires IV antibiotics for 6 weeks. Which vascular access device is MOST appropriate?
- Short peripheral IV catheter replaced every 72-96 hours
- Non-tunneled central venous catheter
- PICC line for outpatient OPAT therapy (Correct answer)
- Implanted port with weekly needle access
Correct answer: PICC line for outpatient OPAT therapy
A PICC line is the device of choice for outpatient parenteral antibiotic therapy (OPAT) lasting weeks, allowing the patient to complete treatment at home.
Question 4: In a pediatric patient with a tunneled CVC, the nurse notes the cuff is visible outside the exit site. This finding indicates:
- Normal catheter positioning for this device type
- Catheter migration that requires provider notification and evaluation (Correct answer)
- The cuff has dissolved and the catheter should be removed immediately
- No concern as long as the catheter flushes freely
Correct answer: Catheter migration that requires provider notification and evaluation
A visible cuff means the catheter has migrated outward; the provider must be notified because the cuff no longer provides the antibacterial and anchoring barrier it is designed to create.
Question 5: Which strategy is MOST effective in reducing peripherally inserted catheter-associated infections in the neonatal ICU?
- Changing all IV tubing every 24 hours regardless of use
- Implementing a catheter bundle including hand hygiene, maximal sterile barriers, and CHG skin antisepsis (Correct answer)
- Using povidone-iodine instead of chlorhexidine for all neonates
- Replacing peripheral catheters every 48 hours routinely
Correct answer: Implementing a catheter bundle including hand hygiene, maximal sterile barriers, and CHG skin antisepsis
Evidence-based central line bundles incorporating hand hygiene, maximal sterile barriers, and appropriate skin antisepsis are the most effective strategy to prevent catheter-related infections in the NICU.
Question 6: A pediatric patient's implanted port is accessed using a non-coring (Huber) needle. The nurse cannot aspirate blood return but the infusion runs freely. The BEST next action is:
- Proceed with infusion since it runs freely
- Reposition the patient (arm raise, deep breath, position change) and retry aspiration (Correct answer)
- Remove and re-access the port with a larger Huber needle
- Flush with 20 mL normal saline forcefully to clear the occlusion
Correct answer: Reposition the patient (arm raise, deep breath, position change) and retry aspiration
Positional maneuvers can dislodge a fibrin sheath or tip positional occlusion causing blood return failure; if unsuccessful, further evaluation such as contrast study may be needed.
Question 7: Which age-appropriate pain scale is recommended for assessing procedural pain during IV insertion in a 3-year-old child who can communicate verbally?
- Numeric Rating Scale (NRS) 0-10
- FLACC scale (Face, Legs, Activity, Cry, Consolability)
- FACES Pain Rating Scale (Wong-Baker) (Correct answer)
- Visual Analog Scale (VAS)
Correct answer: FACES Pain Rating Scale (Wong-Baker)
The FACES Pain Rating Scale is validated for children 3 years and older who can communicate, using facial expressions to help the child self-report pain level.
VA-BC Pediatric Access 5
A 5-year-old with sickle cell disease requires frequent IV access.
Which vascular access strategy is MOST appropriate for long-term management?