VABC Pediatric Access 2 — Questions and Answers
Question 1: Which vein is the preferred site for peripheral IV access in a neonate when antecubital and hand veins are unavailable?
- Femoral vein
- Scalp vein (Correct answer)
- Subclavian vein
- Internal jugular vein
Correct answer: Scalp vein
Scalp veins are an acceptable and commonly used peripheral IV site in neonates when extremity veins are not accessible.
Question 2: What is the maximum recommended dwell time for a peripheral IV catheter in a pediatric patient?
- 24 hours
- 48 hours
- 72–96 hours (Correct answer)
- 7 days
Correct answer: 72–96 hours
Current guidelines recommend rotating peripheral IV sites every 72–96 hours in pediatric patients, or sooner if signs of complications arise.
Question 3: A 3-year-old presents with dehydration and multiple failed peripheral IV attempts. Which vascular access device is most appropriate as an immediate bridge?
- PICC line
- Intraosseous device (Correct answer)
- Tunneled central venous catheter
- Implanted port
Correct answer: Intraosseous device
Intraosseous access provides rapid, reliable vascular access in pediatric emergencies when peripheral IV attempts have failed.
Question 4: Which of the following is a contraindication to intraosseous (IO) insertion in a pediatric patient?
- Hypovolemic shock
- Fracture in the target bone (Correct answer)
- Cardiac arrest
- Status epilepticus
Correct answer: Fracture in the target bone
A fracture in the target bone is a contraindication to IO insertion at that site because fluid may extravasate through the fracture.
Question 5: When calculating catheter-to-vein ratio for pediatric peripheral IVs, what is the maximum recommended ratio to minimize thrombosis risk?
- 25%
- 33% (Correct answer)
- 45%
- 50%
Correct answer: 33%
The catheter should occupy no more than 33% of the vessel lumen to allow adequate blood flow and reduce thrombophlebitis risk.
Question 6: Which gauge catheter is most appropriate for routine peripheral IV placement in a 6-month-old infant?
- 14 gauge
- 18 gauge
- 22–24 gauge (Correct answer)
- 26 gauge
Correct answer: 22–24 gauge
22–24 gauge catheters are standard for infants, balancing adequate flow rates with vessel size and minimizing trauma.
Question 7: What is the primary advantage of using ultrasound guidance for peripheral IV placement in pediatric patients with difficult access?
- Eliminates the need for topical anesthesia
- Allows visualization of deeper veins not visible or palpable (Correct answer)
- Reduces catheter dwell time requirements
- Prevents all complications of IV therapy
Correct answer: Allows visualization of deeper veins not visible or palpable
Ultrasound guidance enables cannulation of deeper veins that cannot be seen or felt, significantly improving first-attempt success rates in difficult pediatric access.
VABC Pediatric Access 2
Which vein is the preferred site for peripheral IV access in a neonate when antecubital and hand veins are unavailable?