VABC Insertion Techniques & Complications Management 3 — Questions and Answers
Question 1: A patient with a newly placed tunneled CVC develops fever, chills, and erythema along the tunnel tract 8 days post-insertion. Which management is MOST appropriate?
- Administer oral antibiotics and monitor for 48 hours
- Remove the catheter and initiate systemic antibiotics (Correct answer)
- Initiate antibiotic lock therapy through the catheter
- Apply topical mupirocin to the exit site and reassess in 24 hours
Correct answer: Remove the catheter and initiate systemic antibiotics
Tunnel tract infection extending more than 2 cm from the exit site requires catheter removal along with systemic antibiotic therapy.
Question 2: When performing internal jugular vein cannulation, the needle is inserted at the apex of the triangle formed by the two heads of the sternocleidomastoid muscle. In what direction should the needle be angled?
- Medially toward the trachea at 45 degrees
- Laterally away from the carotid artery at 30–45 degrees toward the ipsilateral nipple (Correct answer)
- Straight down perpendicular to the skin surface
- Posteriorly toward the cervical spine at 60 degrees
Correct answer: Laterally away from the carotid artery at 30–45 degrees toward the ipsilateral nipple
The needle is directed laterally at 30–45 degrees toward the ipsilateral nipple to avoid the carotid artery and approach the internal jugular vein.
Question 3: A post-procedure chest X-ray shows the tip of a CVC at the junction of the right atrium and superior vena cava. What is the MOST appropriate action?
- Withdraw the catheter 1–2 cm to reposition the tip in the lower SVC (Correct answer)
- Accept the position as it is within acceptable range
- Advance the catheter further into the right atrium for optimal flow
- Remove and replace the catheter in the opposite side
Correct answer: Withdraw the catheter 1–2 cm to reposition the tip in the lower SVC
The ideal CVC tip position is in the lower one-third of the SVC; a tip at the SVC-RA junction should be withdrawn slightly to reduce arrhythmia and perforation risk.
Question 4: Which complication is MOST associated with subclavian vein catheterization compared to internal jugular or femoral approaches?
- Catheter-related bloodstream infection
- Arterial puncture
- Pneumothorax (Correct answer)
- Venous air embolism
Correct answer: Pneumothorax
The subclavian approach carries the highest risk of pneumothorax due to the proximity of the lung apex to the insertion site.
Question 5: During a PICC insertion, the catheter advances with resistance after passing the shoulder. Which maneuver is MOST likely to resolve the issue?
- Apply traction to the arm and extend it fully
- Have the patient turn their head toward the ipsilateral shoulder and tuck their chin (Correct answer)
- Have the patient raise the ipsilateral arm above their head
- Flush the catheter with normal saline to lubricate the lumen
Correct answer: Have the patient turn their head toward the ipsilateral shoulder and tuck their chin
Turning the head toward the ipsilateral shoulder and tucking the chin compresses the ipsilateral jugular vein, helping redirect the catheter into the SVC rather than up the jugular.
Question 6: A patient develops sudden onset dyspnea, chest pain, and hypotension immediately after central line insertion. Breath sounds are absent on the right. What is the PRIORITY intervention?
- Administer oxygen and observe for 30 minutes
- Obtain a STAT chest X-ray
- Perform needle decompression of the right chest at the second intercostal space, midclavicular line (Correct answer)
- Remove the central line immediately
Correct answer: Perform needle decompression of the right chest at the second intercostal space, midclavicular line
These findings are consistent with tension pneumothorax, a life-threatening emergency requiring immediate needle decompression without waiting for imaging.
Question 7: Which of the following represents a Grade 4 phlebitis finding according to the INS Phlebitis Scale?
- Erythema with or without pain at the IV site
- Pain along the vein with erythema and streak formation
- Pain along the vein, erythema, streak, and palpable venous cord greater than 1 inch
- Pain, erythema, streak, palpable cord, and purulent drainage (Correct answer)
Correct answer: Pain, erythema, streak, palpable cord, and purulent drainage
Grade 4 phlebitis on the INS scale includes all classic signs plus purulent drainage at the site, indicating advanced infection.
VABC Insertion Techniques & Complications Management 3
A patient with a newly placed tunneled CVC develops fever, chills, and erythema along the tunnel tract 8 days post-insertion.
Which management is MOST appropriate?