VABC Maintenance & Troubleshooting of Vascular Access Devices 4

Question 1

Pinch-off syndrome is a mechanical complication specific to which type of vascular access device?

Accepted Answer

Subcutaneously implanted ports with catheters placed via the subclavian vein

Answer

Pinch-off syndrome occurs when the catheter of a subclavian-inserted port is compressed between the clavicle and first rib, causing intermittent or complete occlusion and catheter fracture risk.

Question 2

A patient with an implanted port reports positional blood return — return is present when the arm is raised but absent in a neutral position. The MOST likely cause is:

Accepted Answer

Catheter tip malposition

Answer

Positional blood return that changes with arm or body position strongly suggests catheter tip malposition into a smaller vessel or against a vessel wall.

Question 3

Which radiographic finding on chest X-ray confirms that a PICC tip is correctly positioned?

Accepted Answer

Tip at the cavoatrial junction (lower SVC/right atrium junction)

Answer

The optimal PICC tip position is at or just above the cavoatrial junction (lower SVC), which ensures adequate blood flow for hemodilution of infusates.

Question 4

A fibrin sheath encasing a catheter tip is BEST treated with which pharmacologic intervention?

Accepted Answer

Alteplase (tPA) dwell followed by forceful aspiration

Answer

Alteplase dwell therapy can dissolve fibrin sheaths; if unsuccessful, radiologic stripping of the sheath may be required.

Question 5

When a patient experiences sudden onset of dyspnea, chest pain, and hypotension during central line tubing change, air embolism should be suspected. What is the IMMEDIATE positioning intervention?

Accepted Answer

Left lateral decubitus (Durant's maneuver) with Trendelenburg positioning

Answer

Left lateral decubitus with Trendelenburg (head down) positions the air bubble in the right ventricle apex, preventing it from entering the pulmonary circulation.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Maintenance & Troubleshooting of Vascular Access Devices 4