VA-BC Ultrasound Guidance 2 — Questions and Answers
Question 1: Which ultrasound probe orientation allows visualization of the needle tip entering the vessel lumen in real time during PICC insertion?
- Transverse (short-axis) view
- Longitudinal (long-axis) view (Correct answer)
- Oblique view
- Panoramic view
Correct answer: Longitudinal (long-axis) view
The longitudinal (long-axis) view aligns the probe parallel to the vessel, allowing continuous visualization of the entire needle shaft and tip as it enters the lumen.
Question 2: When using ultrasound to assess for a catheter tip malposition into the internal jugular vein, which finding confirms the malposition?
- Hyperechoic line visible in the subclavian vein
- Catheter visible in the IJV lumen on ultrasound (Correct answer)
- Absence of color flow in the axillary vein
- Increased depth of the basilic vein
Correct answer: Catheter visible in the IJV lumen on ultrasound
Visualizing the catheter as a hyperechoic structure within the IJV lumen on ultrasound confirms malposition into that vessel.
Question 3: A vascular access nurse is scanning a patient's arm and notes a vessel that collapses completely with gentle probe pressure. This finding most likely indicates:
- A thrombosed vein
- An artery
- A patent vein (Correct answer)
- A lymph node
Correct answer: A patent vein
Patent veins are compressible and collapse easily under gentle probe pressure, distinguishing them from arteries and thrombosed vessels.
Question 4: What is the primary advantage of using a sterile ultrasound probe cover and gel during vascular access procedures?
- Improves image resolution by 50%
- Maintains a sterile field to reduce infection risk (Correct answer)
- Eliminates the need for skin antisepsis
- Allows the probe to be used without coupling gel
Correct answer: Maintains a sterile field to reduce infection risk
Sterile probe covers and gel maintain the sterile field during vascular access, reducing the risk of catheter-related bloodstream infection.
Question 5: During ultrasound-guided venipuncture, the nurse observes the needle tip pushing the anterior vessel wall inward without entering the lumen. This is called:
- Posterior wall puncture
- Tenting (Correct answer)
- Hydrodissection
- Shadowing
Correct answer: Tenting
Tenting occurs when the needle indents the anterior vessel wall without penetrating it, often requiring slight advancement or angle adjustment to enter the lumen.
Question 6: Which structure appears as a pulsatile, non-compressible, round hypoechoic structure on ultrasound in a transverse view?
- Peripheral vein
- Lymph node
- Artery (Correct answer)
- Tendon
Correct answer: Artery
Arteries appear as round, pulsatile, non-compressible structures on transverse ultrasound, distinguishing them from veins which are easily compressed.
Question 7: When obtaining ultrasound consent and documenting a pre-procedure vessel assessment, which measurement is most critical to record for PICC placement selection?
- Vessel depth from skin surface (Correct answer)
- Vessel color on Doppler
- Acoustic shadowing distance
- Probe frequency used
Correct answer: Vessel depth from skin surface
Vessel depth guides catheter selection and technique; veins deeper than 1.5 cm typically require ultrasound guidance and longer needles for successful cannulation.
VA-BC Ultrasound Guidance 2
Which ultrasound probe orientation allows visualization of the needle tip entering the vessel lumen in real time during PICC insertion?