VABC Maintenance & Troubleshooting of Vascular Access Devices 3 — Questions and Answers
Question 1: A precipitate occlusion caused by calcium-phosphate incompatibility in a PICC is best treated with which agent?
- Alteplase (tPA)
- Sodium bicarbonate 8.4%
- 0.1N hydrochloric acid (HCl) (Correct answer)
- Urokinase
Correct answer: 0.1N hydrochloric acid (HCl)
Calcium-phosphate precipitates are alkaline and dissolve in acidic solutions; 0.1N hydrochloric acid is the standard treatment for this type of non-thrombotic occlusion.
Question 2: How long should alteplase (1 mg/mL) dwell in a catheter when treating a thrombotic occlusion, per standard protocol?
- 5–10 minutes
- 30–60 minutes with reassessment up to 2 hours (Correct answer)
- 4–6 hours
- 12–24 hours
Correct answer: 30–60 minutes with reassessment up to 2 hours
Standard alteplase protocol calls for a 30–60 minute dwell time, with reassessment; if patency is not restored, a second dwell of up to 2 hours total may be used.
Question 3: Which dressing type is preferred for CVAD insertion sites in adults without excessive perspiration or bleeding?
- Gauze and tape
- Transparent semipermeable membrane (TSM) dressing (Correct answer)
- Hydrocolloid dressing
- Non-occlusive gauze dressing
Correct answer: Transparent semipermeable membrane (TSM) dressing
TSM dressings allow continuous visualization of the insertion site, reduce infection risk, and require less frequent changes than gauze dressings.
Question 4: A chlorhexidine-impregnated sponge dressing is indicated for which patient population according to CDC guidelines?
- All pediatric patients under 2 years
- Adults with CVADs when the catheter-related bloodstream infection (CRBSI) rate is not decreasing despite standard precautions (Correct answer)
- Immunocompromised patients only
- Patients receiving total parenteral nutrition (TPN)
Correct answer: Adults with CVADs when the catheter-related bloodstream infection (CRBSI) rate is not decreasing despite standard precautions
CDC guidelines recommend chlorhexidine-impregnated dressings as an adjunct measure for adults when CRBSI rates remain elevated despite standard prevention bundles.
Question 5: When changing a CVAD dressing, the nurse should cleanse the site with chlorhexidine gluconate (CHG) using which technique?
- Gentle circular motion from outer edge inward
- Back-and-forth scrubbing motion, working outward from the insertion site
- Single wipe in one direction only
- Friction scrub from insertion site outward with 30-second contact time (Correct answer)
Correct answer: Friction scrub from insertion site outward with 30-second contact time
CHG requires a friction scrub moving from the insertion site outward, with at least 30 seconds of contact and full dry time to maximize antimicrobial effectiveness.
Question 6: A patient with a tunneled CVC reports redness, warmth, and tenderness along the tunnel track. This presentation is MOST consistent with:
- Exit-site infection
- Tunnel infection (Correct answer)
- Port pocket infection
- Catheter-related bloodstream infection (CRBSI)
Correct answer: Tunnel infection
Inflammation and tenderness extending along the subcutaneous tunnel (more than 2 cm from the exit site) defines a tunnel infection, which typically requires catheter removal.
Question 7: What is the MINIMUM volume of flush solution recommended to clear a standard PICC lumen after medication administration?
- 1 mL
- 3 mL
- 10 mL (Correct answer)
- 20 mL
Correct answer: 10 mL
INS guidelines recommend a minimum of 10 mL of normal saline to flush CVADs after medication administration to ensure full delivery and prevent precipitation.
VABC Maintenance & Troubleshooting of Vascular Access Devices 3
A precipitate occlusion caused by calcium-phosphate incompatibility in a PICC is best treated with which agent?