VABC Insertion Techniques & Complications Management 2

Question 1

During ultrasound-guided PICC insertion, the needle tip is visualized in the short-axis view. What is the primary limitation of this approach compared to long-axis?

Accepted Answer

The shaft of the needle may be out of plane and difficult to track

Answer

Short-axis view shows the needle tip as a dot but cannot continuously track the shaft, risking inadvertent posterior wall puncture.

Question 2

A patient develops a hematoma at the PICC insertion site immediately after insertion. Which action is the MOST appropriate initial response?

Accepted Answer

Apply firm manual pressure for at least 5 minutes

Answer

Firm manual pressure applied directly over the hematoma for at least 5 minutes is the first-line intervention to stop bleeding.

Question 3

When using the Seldinger technique for CVC insertion, the guidewire is inserted and the patient suddenly develops PVCs on the cardiac monitor. What is the most likely cause?

Accepted Answer

The guidewire has advanced into the right ventricle

Answer

A guidewire advanced too far into the heart can irritate the right ventricular wall, triggering premature ventricular contractions.

Question 4

Which of the following is the correct sequence for the modified Seldinger technique used in PICC insertion?

Accepted Answer

Venipuncture → guidewire → peel-away introducer → catheter → introducer removal

Answer

The modified Seldinger technique involves venipuncture, guidewire insertion, placement of a peel-away introducer over the wire, threading the catheter, then splitting away the introducer.

Question 5

A nurse inserts a midline catheter and notes blood return is dark red and non-pulsatile. Despite this, the patient's arm becomes swollen and painful within minutes. What has most likely occurred?

Accepted Answer

Lymphatic vessel cannulation

Answer

Lymphatic vessels can produce non-pulsatile, clear to slightly yellow fluid, but cannulation of lymphatics can cause lymphedema and swelling; however, in the antecubital region, a soft tissue hematoma from nearby arterial trauma is also possible — lymphatic cannulation is the classic distractor answer here, but the correct answer is lymphatic vessel cannulation causing lymphedema.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Insertion Techniques & Complications Management 2