VABC Insertion Techniques & Complications Management 5 — Questions and Answers
Question 1: A patient with a totally implanted venous port requires access for the first time since surgical placement 6 weeks ago. The nurse cannot palpate the port septum clearly. Which action is MOST appropriate?
- Use a standard hypodermic needle to access the port
- Attempt access by feel alone using finger pressure to identify the septum edge
- Use ultrasound guidance to locate the port septum before accessing (Correct answer)
- Document inability to access and schedule a port removal
Correct answer: Use ultrasound guidance to locate the port septum before accessing
Ultrasound guidance is recommended when the port cannot be clearly palpated, reducing the risk of coring the port body or missing the septum.
Question 2: When using a non-coring Huber needle to access a port, the needle bevel should be oriented in which direction?
- Bevel facing upward (toward the ceiling) (Correct answer)
- Bevel facing downward (toward the port body)
- Bevel orientation does not matter for Huber needles
- Bevel at a 45-degree angle to the skin surface
Correct answer: Bevel facing upward (toward the ceiling)
Huber needles have a deflected tip; the bevel is oriented upward so the needle enters the septum and deflects laterally rather than coring out a plug of silicone.
Question 3: A patient develops pain, swelling, and erythema over their implanted port site 3 days after access. A pocket infection is suspected. Which assessment finding would most strongly support the need for port explantation rather than antibiotic salvage?
- Temperature of 38.2°C
- C-reactive protein of 12 mg/L
- Fluctuance and skin breakdown over the port pocket (Correct answer)
- Blood cultures positive for coagulase-negative Staphylococcus
Correct answer: Fluctuance and skin breakdown over the port pocket
Fluctuance and skin breakdown indicate abscess formation in the port pocket, which typically cannot be managed with antibiotics alone and requires surgical removal.
Question 4: Which catheter characteristic is MOST associated with increased risk of catheter-associated thrombosis?
- Polyurethane material
- Smaller catheter-to-vein ratio
- Power-injectable rated catheter
- Silicone material with multiple lumens (Correct answer)
Correct answer: Silicone material with multiple lumens
Silicone catheters and larger catheter-to-vein ratios (occupying more of the vein lumen) are associated with higher thrombosis risk due to material properties and impaired venous flow.
Question 5: A bedside nurse notes that a PICC dressing has become wet and is lifting at the edges after a patient's bath. The insertion site appears clean without signs of infection. What is the correct action?
- Reinforce the dressing with additional tape and change at the scheduled time
- Remove and replace the dressing using aseptic technique immediately (Correct answer)
- Apply a dry gauze pad over the wet dressing and document the finding
- Notify the vascular access team to assess the need for PICC replacement
Correct answer: Remove and replace the dressing using aseptic technique immediately
A wet, loose, or compromised dressing must be changed immediately using aseptic technique to maintain the sterile barrier and prevent CRBSI.
Question 6: During subclavian central line insertion, the clinician notes bright red, pulsatile blood entering the syringe. What is the MOST appropriate immediate action?
- Advance the guidewire to confirm position before withdrawing the needle
- Withdraw the needle and apply firm direct pressure for at least 10 minutes (Correct answer)
- Insert the catheter and obtain an arterial blood gas to confirm placement
- Clamp the needle and call for an emergency vascular surgery consult
Correct answer: Withdraw the needle and apply firm direct pressure for at least 10 minutes
Inadvertent subclavian artery puncture requires immediate needle withdrawal and sustained direct pressure, though accessing the subclavian artery makes pressure application difficult compared to more compressible sites.
Question 7: A patient with a PICC presents with neck swelling, arm edema, and difficulty swallowing 2 weeks post-insertion. Imaging confirms superior vena cava syndrome. Which factor is MOST likely to have contributed to this complication?
- Use of a 5 French single-lumen PICC
- Catheter tip malposition in the right subclavian vein
- Prior history of multiple central venous catheterizations causing venous stenosis (Correct answer)
- Use of chlorhexidine dressing rather than transparent semipermeable membrane
Correct answer: Prior history of multiple central venous catheterizations causing venous stenosis
Repeated central venous catheterizations cause intimal injury and scarring that can lead to venous stenosis or thrombosis, predisposing patients to SVC syndrome.
VABC Insertion Techniques & Complications Management 5
A patient with a totally implanted venous port requires access for the first time since surgical placement 6 weeks ago.
The nurse cannot palpate the port septum clearly.
Which action is MOST appropriate?