VABC Complication Management 5

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?

Accepted Answer

Remove the catheter and initiate antifungal therapy for at least 14 days after last positive culture

Answer

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?

Accepted Answer

Perform a complete dressing change using aseptic technique

Answer

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?

Accepted Answer

Catheter tip migration into the right atrium causing arrhythmia

Answer

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?

Accepted Answer

Internal jugular central venous catheter

Answer

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?

Accepted Answer

Decreased or absent breath sounds with hyperresonance on the ipsilateral side

Answer

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.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Complication Management 5