VABC Pediatric Access 4 — Questions and Answers
Question 1: A pediatric patient with sickle cell disease requires frequent blood transfusions. Which vascular access device best balances repeated access needs with infection risk?
- Peripheral IV placed at each visit
- Non-tunneled central venous catheter
- Tunneled cuffed catheter
- Implanted port (Correct answer)
Correct answer: Implanted port
An implanted port offers the lowest infection risk for frequent but intermittent access needs, with no external components when not in use.
Question 2: Which intraosseous insertion site is preferred in children over 6 years of age when tibial access is unavailable?
- Iliac crest
- Distal femur (Correct answer)
- Sternum
- Calcaneus
Correct answer: Distal femur
The distal femur is an alternative IO insertion site in older children and adults when the proximal tibia is not accessible.
Question 3: When securing a peripheral IV in a toddler, which method is most appropriate to prevent accidental dislodgement while allowing ongoing assessment?
- Circumferential tape wrap covering the entire insertion site
- Sterile transparent dressing with site visible, and a splint as needed (Correct answer)
- Ace bandage wrapped from fingertips to elbow
- No dressing — only tape to allow frequent checks
Correct answer: Sterile transparent dressing with site visible, and a splint as needed
A transparent semipermeable membrane dressing keeps the site visible for ongoing assessment while securing the catheter, with a splint added for joint sites if needed.
Question 4: Which clinical sign BEST indicates infiltration of a peripheral IV in a preverbal child who cannot report symptoms?
- Increased flow rate on the infusion pump
- Localized swelling, firmness, or skin blanching around the insertion site (Correct answer)
- Elevated heart rate
- Catheter draws back blood easily
Correct answer: Localized swelling, firmness, or skin blanching around the insertion site
Localized swelling, induration, or blanching at the IV site are objective signs of infiltration, especially important in preverbal patients who cannot verbalize pain.
Question 5: A 2-year-old receiving vesicant chemotherapy via peripheral IV develops swelling at the site. What is the FIRST action?
- Increase the infusion rate to dilute the agent
- Stop the infusion immediately and aspirate residual drug before removing the catheter (Correct answer)
- Apply a warm compress and continue infusion at half rate
- Flush the catheter with 10 mL normal saline
Correct answer: Stop the infusion immediately and aspirate residual drug before removing the catheter
When vesicant extravasation is suspected, the infusion must be stopped immediately and residual drug aspirated before catheter removal to limit tissue damage.
Question 6: Which measurement method is used to estimate PICC insertion length in a pediatric patient prior to placement?
- Patient height minus 10 cm
- External measurement from insertion site to the sternal notch and then down to the third intercostal space (Correct answer)
- Chest circumference divided by two
- Weight in kg multiplied by 0.5 cm
Correct answer: External measurement from insertion site to the sternal notch and then down to the third intercostal space
External anatomical measurement from the intended insertion site to the sternal notch and then to the third intercostal space is the standard method for estimating PICC length.
Question 7: In a pediatric patient, which characteristic of a vein makes it a POOR choice for PICC insertion?
- Straight course with no valves visible on ultrasound
- Large diameter relative to catheter size
- Vein located in a joint flexion area (Correct answer)
- Vein visible and palpable without ultrasound
Correct answer: Vein located in a joint flexion area
Veins located at or near joint flexion areas increase the risk of catheter kinking, occlusion, and damage with limb movement.
VABC Pediatric Access 4
A pediatric patient with sickle cell disease requires frequent blood transfusions.
Which vascular access device best balances repeated access needs with infection risk?