VABC Insertion Techniques & Complications Management 4 — Questions and Answers
Question 1: A patient's implanted port is accessed but the nurse cannot aspirate blood. The patient reports no discomfort. What should the nurse assess FIRST?
- Reaccess with a new Huber needle
- Check for catheter pinch-off syndrome using fluoroscopy
- Have the patient perform positional maneuvers such as raising the arm or coughing (Correct answer)
- Flush with 20 mL of normal saline under pressure
Correct answer: Have the patient perform positional maneuvers such as raising the arm or coughing
Positional maneuvers can relieve a fibrin sheath or positional occlusion and are the first-line, non-invasive assessment for inability to aspirate.
Question 2: Pinch-off syndrome is a complication specific to which central venous access approach?
- Internal jugular
- Femoral
- Subclavian via infraclavicular approach (Correct answer)
- Basilic vein PICC
Correct answer: Subclavian via infraclavicular approach
Pinch-off syndrome occurs when the catheter is compressed between the clavicle and first rib, which is unique to the subclavian infraclavicular insertion site.
Question 3: During femoral vein cannulation, the landmark technique uses the mnemonic NAVEL. What does each letter represent in order from lateral to medial?
- Nerve, Artery, Vein, Empty space, Lymphatics (Correct answer)
- Nerve, Artery, Vein, Epigastric vessels, Lymphatics
- Nerve, Anterior fascia, Vein, Empty space, Lymphatics
- Nodule, Artery, Vein, Empty space, Lymphatics
Correct answer: Nerve, Artery, Vein, Empty space, Lymphatics
NAVEL (Nerve, Artery, Vein, Empty space, Lymphatics) describes the lateral-to-medial arrangement of femoral triangle structures below the inguinal ligament.
Question 4: A PICC patient has a confirmed upper extremity DVT. The catheter is still patent and functional and the patient requires continued IV therapy. What is the recommended approach per current guidelines?
- Remove the PICC immediately and place a new one in the contralateral arm
- Anticoagulate and remove the PICC only if it is no longer needed (Correct answer)
- Continue using the PICC without anticoagulation and monitor with weekly ultrasound
- Remove the PICC and convert to a midline catheter
Correct answer: Anticoagulate and remove the PICC only if it is no longer needed
Current guidelines recommend initiating anticoagulation and removing the catheter only when it is no longer needed, balancing thrombosis treatment with ongoing IV access needs.
Question 5: Which of the following steps in aseptic technique is MOST critical for preventing catheter-related bloodstream infections (CRBSI) at the time of insertion?
- Using a 2% chlorhexidine-based antiseptic with alcohol and allowing it to fully dry (Correct answer)
- Wearing sterile gloves only, without a full sterile drape
- Changing the needleless connector every 72 hours
- Flushing with heparinized saline immediately before insertion
Correct answer: Using a 2% chlorhexidine-based antiseptic with alcohol and allowing it to fully dry
Maximal sterile barrier precautions including full sterile drape, gown, gloves, mask, and chlorhexidine-alcohol skin prep (allowed to dry) are the most evidence-based insertion practices to prevent CRBSI.
Question 6: A nurse removes an 18 cm PICC from a patient's basilic vein. After removal, only 15 cm of catheter is retrieved. What should the nurse do IMMEDIATELY?
- Attempt to flush the remaining fragment to the heart
- Apply a tourniquet above the insertion site and notify the physician immediately (Correct answer)
- Document the finding and monitor the patient for 1 hour
- Place the patient in Trendelenburg position and call a code
Correct answer: Apply a tourniquet above the insertion site and notify the physician immediately
Suspected catheter fracture and embolism requires immediate tourniquet application proximal to the site to limit migration, followed by urgent physician notification and imaging.
Question 7: Which tip confirmation method for PICC placement provides real-time intraprocedural tip location without radiation exposure?
- Post-procedure chest X-ray
- Fluoroscopy
- Electrocardiographic (ECG) tip confirmation technology (Correct answer)
- CT scan with contrast
Correct answer: Electrocardiographic (ECG) tip confirmation technology
ECG-based tip confirmation detects changes in the P-wave morphology as the catheter tip approaches the SVC-RA junction, allowing real-time radiation-free tip localization.
VABC Insertion Techniques & Complications Management 4
A patient's implanted port is accessed but the nurse cannot aspirate blood.
The patient reports no discomfort.
What should the nurse assess FIRST?