VABC Pediatric Access 3

Question 1

In a pediatric patient requiring PICC placement, the tip should be positioned at which anatomical location?

Accepted Answer

Superior vena cava–right atrial junction

Answer

The ideal PICC tip position is at the cavoatrial junction (SVC–right atrial junction) to ensure adequate hemodilution of infusates and reduce thrombosis risk.

Question 2

Which of the following fluids requires a central venous access device rather than a peripheral IV in pediatric patients?

Accepted Answer

Total parenteral nutrition with >10% dextrose

Answer

Solutions with osmolarity >900 mOsm/L, such as TPN with high dextrose concentrations, must be administered via central venous access to prevent severe phlebitis.

Question 3

A 10-year-old child with cancer requires long-term intermittent IV chemotherapy over the next 12 months. Which vascular access device is most appropriate?

Accepted Answer

Implanted port

Answer

An implanted port is ideal for long-term intermittent access, offering reduced infection risk, preserved body image, and minimal maintenance between cycles.

Question 4

When using the basilic vein for PICC insertion in a pediatric patient, which position of the arm optimizes vessel diameter?

Accepted Answer

Arm abducted 45–90 degrees from the body

Answer

Abducting the arm 45–90 degrees increases basilic vein diameter and straightens the venous pathway, improving cannulation success.

Question 5

Which complication is MOST commonly associated with PICC lines in neonates compared to older pediatric patients?

Accepted Answer

Cardiac tamponade from tip migration

Answer

Cardiac tamponade from catheter tip migration into the pericardial space is a rare but disproportionately reported complication in neonates due to their small size and catheter mobility.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Pediatric Access 3