VABC Maintenance & Troubleshooting of Vascular Access Devices 2 — Questions and Answers
Question 1: Which flushing solution is recommended by INS guidelines for maintaining patency in most central venous access devices (CVADs) in adults?
- Heparin 100 units/mL
- Normal saline (0.9% NaCl) (Correct answer)
- Bacteriostatic saline
- Sterile water
Correct answer: Normal saline (0.9% NaCl)
INS guidelines recommend normal saline (0.9% NaCl) as the primary flush solution for most CVADs in adults, as it is effective and avoids heparin-related complications.
Question 2: When performing the push-pause flushing technique, what is the primary goal of creating turbulent flow?
- Dilate the catheter lumen
- Remove debris and prevent biofilm formation (Correct answer)
- Increase medication delivery speed
- Reduce patient discomfort
Correct answer: Remove debris and prevent biofilm formation
The push-pause technique creates turbulent flow that dislodges debris and prevents biofilm accumulation on catheter walls.
Question 3: A patient's PICC line has sluggish flow but blood return is still present. Which type of occlusion is MOST likely?
- Complete thrombotic occlusion
- Partial thrombotic occlusion (Correct answer)
- Lipid precipitate occlusion
- Mechanical kink occlusion
Correct answer: Partial thrombotic occlusion
Partial thrombotic occlusion presents with sluggish flow and preserved blood return because the thrombus has not completely blocked the lumen.
Question 4: The SASH protocol for flushing and locking a PICC line stands for which sequence?
- Saline, Antibiotic, Saline, Heparin
- Saline, Administer medication, Saline, Heparin (Correct answer)
- Saline, Aspirate, Saline, Hold
- Saline, Administer, Stop, Heparin
Correct answer: Saline, Administer medication, Saline, Heparin
SASH stands for Saline flush, Administer medication, Saline flush, Heparin lock — used when a heparin lock is indicated.
Question 5: Which action should be taken FIRST when a catheter occlusion is suspected?
- Instill alteplase immediately
- Apply a thrombolytic dwell
- Assess for external mechanical causes such as kinking or a closed clamp (Correct answer)
- Obtain a chest X-ray
Correct answer: Assess for external mechanical causes such as kinking or a closed clamp
Before using pharmacologic interventions, clinicians must rule out mechanical causes — such as a closed clamp, kinked tubing, or catheter malposition — as these are simple and immediately correctable.
Question 6: A needleless connector with negative pressure displacement is associated with which complication if disconnected before clamping?
- Air embolism
- Blood reflux into the catheter lumen (Correct answer)
- Medication extravasation
- Catheter tip migration
Correct answer: Blood reflux into the catheter lumen
Negative-displacement connectors draw fluid back into the catheter upon disconnection, causing blood reflux that can lead to intraluminal clot formation.
Question 7: According to best practice, how often should needleless connectors on CVADs be changed?
- Every 24 hours
- Every 96 hours or per manufacturer recommendation, or when soiled/compromised (Correct answer)
- Every 7 days regardless of condition
- Only when the dressing is changed
Correct answer: Every 96 hours or per manufacturer recommendation, or when soiled/compromised
INS standards recommend changing needleless connectors no more frequently than every 96 hours, or per manufacturer guidelines, or when visibly soiled, damaged, or removed.
VABC Maintenance & Troubleshooting of Vascular Access Devices 2
Which flushing solution is recommended by INS guidelines for maintaining patency in most central venous access devices (CVADs) in adults?