Practice Test Geeks(VABC) Vascular Access Board Certification Practice Test
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Maintenance & Troubleshooting of Vascular Access Devices Flashcards

7 cards from real VABC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. Pinch-off syndrome is a mechanical complication specific to which type of vascular access device?

    Answer: Subcutaneously implanted ports with catheters placed via the subclavian vein

    Pinch-off syndrome occurs when the catheter of a subclavian-inserted port is compressed between the clavicle and first rib, causing intermittent or complete occlusion and catheter fracture risk.

  2. A patient with an implanted port reports positional blood return — return is present when the arm is raised but absent in a neutral position. The MOST likely cause is:

    Answer: Catheter tip malposition

    Positional blood return that changes with arm or body position strongly suggests catheter tip malposition into a smaller vessel or against a vessel wall.

  3. Which radiographic finding on chest X-ray confirms that a PICC tip is correctly positioned?

    Answer: Tip at the cavoatrial junction (lower SVC/right atrium junction)

    The optimal PICC tip position is at or just above the cavoatrial junction (lower SVC), which ensures adequate blood flow for hemodilution of infusates.

  4. A fibrin sheath encasing a catheter tip is BEST treated with which pharmacologic intervention?

    Answer: Alteplase (tPA) dwell followed by forceful aspiration

    Alteplase dwell therapy can dissolve fibrin sheaths; if unsuccessful, radiologic stripping of the sheath may be required.

  5. When a patient experiences sudden onset of dyspnea, chest pain, and hypotension during central line tubing change, air embolism should be suspected. What is the IMMEDIATE positioning intervention?

    Answer: Left lateral decubitus (Durant's maneuver) with Trendelenburg positioning

    Left lateral decubitus with Trendelenburg (head down) positions the air bubble in the right ventricle apex, preventing it from entering the pulmonary circulation.

  6. Which characteristic MOST reliably differentiates catheter-related bloodstream infection (CRBSI) from a contaminated blood culture?

    Answer: Differential time to positivity (DTP) ≥2 hours between catheter and peripheral cultures

    A differential time to positivity ≥2 hours (catheter culture positive before peripheral) is a validated diagnostic criterion indicating the catheter is the infection source.

  7. After alteplase instillation for a thrombotic occlusion fails to restore patency, the NEXT appropriate step is:

    Answer: Repeat the alteplase dwell for a second instillation up to 2 hours, then consider imaging

    If the first alteplase dwell does not restore patency, a second instillation is appropriate; if both fail, imaging studies are indicated to evaluate for fibrin sheath or other structural causes.