VABC Complication Management 5 — Questions and Answers
Question 1: A patient on home TPN through a tunneled CVC spikes a fever. Blood cultures are drawn and the catheter is retained. After 72 hours, cultures remain positive for Candida albicans. What is the correct management?
- Continue antifungal therapy and retain the catheter
- Remove the catheter and initiate antifungal therapy for at least 14 days after last positive culture (Correct answer)
- Switch to oral fluconazole and observe
- Perform antibiotic lock therapy with antifungal agent
Correct answer: Remove the catheter and initiate antifungal therapy for at least 14 days after last positive culture
Candida CRBSI mandates catheter removal; antifungal therapy should continue for at least 14 days after the last positive blood culture per IDSA guidelines.
Question 2: A nurse notes a PICC dressing that is damp and lifting at the edges. The patient is afebrile and the insertion site looks clean. What is the correct action?
- Reinforce the current dressing with additional tape
- Perform a complete dressing change using aseptic technique (Correct answer)
- Leave the dressing and reassess in 24 hours
- Remove the PICC and insert a new one at a different site
Correct answer: Perform a complete dressing change using aseptic technique
A compromised dressing — even without site infection signs — must be changed immediately using aseptic technique to prevent bacterial entry and CRBSI.
Question 3: During power injection of contrast through a power-injectable PICC, the patient reports sudden chest pain and the monitor shows bradycardia. What complication should be suspected?
- Anaphylactic reaction to contrast media
- Catheter tip migration into the right atrium causing arrhythmia (Correct answer)
- Pulmonary embolism from dislodged thrombus
- Vasovagal response to anxiety
Correct answer: Catheter tip migration into the right atrium causing arrhythmia
Sudden chest pain with arrhythmia during contrast injection suggests catheter tip migration into the right atrium or ventricle, causing cardiac irritation.
Question 4: A patient with chronic kidney disease (CKD stage 4) requires short-term IV antibiotics. Which vascular access type is preferred to preserve future dialysis access sites?
- Basilic vein PICC in the dominant arm
- Internal jugular central venous catheter (Correct answer)
- Subclavian central venous catheter
- Peripherally inserted midline catheter in the forearm
Correct answer: Internal jugular central venous catheter
In CKD patients, the subclavian vein should be avoided due to stenosis risk, and peripheral arm veins preserved for fistula creation; an internal jugular CVC is preferred for short-term access.
Question 5: What is the hallmark physical finding of a post-insertion pneumothorax following subclavian vein catheterization?
- Dullness to percussion on the ipsilateral side
- Decreased or absent breath sounds with hyperresonance on the ipsilateral side (Correct answer)
- Bilateral decrease in breath sounds
- Mediastinal shift toward the affected side
Correct answer: Decreased or absent breath sounds with hyperresonance on the ipsilateral side
Pneumothorax presents with decreased or absent breath sounds and hyperresonance to percussion on the side of the catheter insertion due to air in the pleural space.
Question 6: A vascular access nurse discovers that a patient's implanted port has a crack in the catheter body identified on chest X-ray after the patient reported feeling resistance when flushing. What is the most serious risk of this finding?
- Increased infection risk at the port pocket
- Catheter embolism if a fragment breaks off into the bloodstream (Correct answer)
- Fibrin sheath formation around the crack
- Contrast extravasation during imaging
Correct answer: Catheter embolism if a fragment breaks off into the bloodstream
A cracked catheter body risks fracture and embolism of the catheter fragment into the pulmonary vasculature or heart, requiring urgent interventional retrieval.
Question 7: Which intervention is most effective in reducing needleless connector-related CRBSI in ICU patients?
- Replacing connectors every 24 hours
- Consistent scrubbing of the hub with 70% alcohol for at least 15 seconds before access (Correct answer)
- Using positive-displacement connectors only
- Flushing with heparinized saline after every access
Correct answer: Consistent scrubbing of the hub with 70% alcohol for at least 15 seconds before access
Vigorous scrubbing of needleless connectors with 70% alcohol for at least 15 seconds (scrub the hub) before each access is the most evidence-based method to reduce hub-related CRBSI.
VABC Complication Management 5
A patient on home TPN through a tunneled CVC spikes a fever.
Blood cultures are drawn and the catheter is retained.
After 72 hours, cultures remain positive for Candida albicans.
What is the correct management?