VABC Complication Management 2 — Questions and Answers
Question 1: A patient develops pinch-off syndrome with a PICC line. Which finding on chest X-ray is most indicative of this complication?
- Catheter tip migration to the right atrium
- Compression of the catheter between the clavicle and first rib (Correct answer)
- Fibrin sheath formation around the catheter
- Catheter kinking at the insertion site
Correct answer: Compression of the catheter between the clavicle and first rib
Pinch-off syndrome occurs when the catheter is compressed between the clavicle and first rib, visible on X-ray as a narrowing or angle change in that region.
Question 2: Which intervention is first-line for managing a mild air embolism during central venous catheter insertion?
- Immediate surgical consult
- Place patient in left lateral Trendelenburg position and administer 100% oxygen (Correct answer)
- Administer IV heparin bolus
- Remove the catheter immediately
Correct answer: Place patient in left lateral Trendelenburg position and administer 100% oxygen
Left lateral Trendelenburg (Durant's maneuver) traps air in the right ventricle apex and 100% oxygen accelerates nitrogen reabsorption.
Question 3: A patient with a tunneled CVC develops a tunnel infection with purulent drainage but no bacteremia. What is the most appropriate management?
- Systemic antibiotics alone for 14 days
- Catheter removal plus systemic antibiotics (Correct answer)
- Local wound care only
- Antibiotic lock therapy plus systemic antibiotics
Correct answer: Catheter removal plus systemic antibiotics
Tunnel infections with purulence require catheter removal along with systemic antibiotics because the infection cannot be cleared with the device in place.
Question 4: During a PICC insertion attempt, blood return is lost and the patient reports pain along the arm. What complication is most likely?
- Catheter tip malposition in the axillary vein
- Arterial puncture of the brachial artery
- Venous spasm causing flow obstruction
- Extravasation of flush solution (Correct answer)
Correct answer: Extravasation of flush solution
Loss of blood return with arm pain during PICC insertion is classic for extravasation, where the catheter tip or an introducer breach has allowed fluid to leak into surrounding tissue.
Question 5: A hemodialysis patient's AV fistula has a bruit that has changed from soft and continuous to harsh and discontinuous. What does this indicate?
- Maturation of the fistula is progressing normally
- High-grade stenosis causing turbulent flow (Correct answer)
- Fistula thrombosis with complete occlusion
- Aneurysm formation at the anastomosis
Correct answer: High-grade stenosis causing turbulent flow
A harsh, high-pitched, discontinuous bruit replacing a previously soft continuous bruit indicates significant stenosis causing turbulent, interrupted blood flow.
Question 6: Which organism is most commonly associated with CRBSI in patients receiving total parenteral nutrition (TPN)?
- Staphylococcus aureus
- Escherichia coli
- Candida species (Correct answer)
- Pseudomonas aeruginosa
Correct answer: Candida species
Candida species are the most common CRBSI pathogen in TPN patients because the high-glucose lipid-rich solution is an ideal fungal growth medium.
Question 7: A patient with a port-a-cath cannot have blood aspirated despite brisk flush flow. What is the most likely cause?
- Port needle dislodgment from the septum
- Fibrin tail (one-way valve effect) at the catheter tip (Correct answer)
- Complete thrombotic occlusion
- Catheter fracture
Correct answer: Fibrin tail (one-way valve effect) at the catheter tip
A fibrin tail acting as a one-way valve permits forward flush flow but occludes the catheter tip during aspiration, causing withdrawal occlusion.
VABC Complication Management 2
A patient develops pinch-off syndrome with a PICC line.
Which finding on chest X-ray is most indicative of this complication?