VABC Complication Management 2

Question 1

A patient develops pinch-off syndrome with a PICC line. Which finding on chest X-ray is most indicative of this complication?

Accepted Answer

Compression of the catheter between the clavicle and first rib

Answer

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?

Accepted Answer

Place patient in left lateral Trendelenburg position and administer 100% oxygen

Answer

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?

Accepted Answer

Catheter removal plus systemic antibiotics

Answer

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?

Accepted Answer

Extravasation of flush solution

Answer

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?

Accepted Answer

High-grade stenosis causing turbulent flow

Answer

A harsh, high-pitched, discontinuous bruit replacing a previously soft continuous bruit indicates significant stenosis causing turbulent, interrupted blood flow.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Complication Management 2