VABC Pediatric Access 5 — Questions and Answers
Question 1: What is the primary reason chlorhexidine gluconate (CHG) skin antisepsis is used with caution in neonates under 2 months of age?
- CHG is ineffective against gram-negative organisms in neonates
- Immature neonatal skin allows significant percutaneous absorption causing systemic toxicity (Correct answer)
- CHG causes immediate allergic reactions in all neonates
- CHG degrades rapidly at neonatal body temperature
Correct answer: Immature neonatal skin allows significant percutaneous absorption causing systemic toxicity
The thin, permeable skin of neonates, especially preterm infants, allows CHG to be absorbed systemically, potentially causing chemical burns and systemic toxicity.
Question 2: Which veins should be avoided for PICC insertion in a pediatric patient with chronic kidney disease who may require future hemodialysis?
- Basilic and cephalic veins of the non-dominant arm (Correct answer)
- Antecubital veins of the dominant arm
- Basilic and cephalic veins of the dominant arm
- Forearm veins of either arm
Correct answer: Basilic and cephalic veins of the non-dominant arm
Preserving the basilic and cephalic veins of the non-dominant arm is essential for potential future AV fistula creation in patients with chronic kidney disease.
Question 3: A 5-year-old child has a midline catheter placed in the right basilic vein with the tip confirmed at the mid-upper arm. Which infusate is appropriate for this device?
- Total parenteral nutrition with 20% dextrose
- Vancomycin at standard concentration (Correct answer)
- 3% hypertonic saline
- Continuous vasopressor infusion
Correct answer: Vancomycin at standard concentration
Midline catheters are appropriate for isotonic or near-isotonic infusates such as standard-concentration antibiotics, but are not indicated for vesicants, hyperosmolar solutions, or vasopressors.
Question 4: When performing ultrasound-guided peripheral IV placement in a child, the short-axis (transverse) view is used to:
- Confirm catheter tip position in the superior vena cava
- Identify vessel location, depth, and surrounding structures during needle approach (Correct answer)
- Measure catheter-to-vein ratio in real time
- Detect catheter-associated thrombosis after placement
Correct answer: Identify vessel location, depth, and surrounding structures during needle approach
The short-axis view provides a cross-sectional image that allows the clinician to identify vessel location, assess surrounding structures, and guide needle placement.
Question 5: A neonate requires umbilical venous catheter (UVC) placement. The correct tip position is:
- In the portal vein at the liver hilum
- At the junction of the inferior vena cava and right atrium (Correct answer)
- In the right hepatic vein
- In the left portal vein
Correct answer: At the junction of the inferior vena cava and right atrium
The UVC tip should be positioned at the IVC–right atrial junction to avoid hepatic complications such as portal hypertension or hepatic necrosis.
Question 6: Which factor MOST increases the risk of catheter-associated bloodstream infection (CLABSI) in pediatric patients with central venous catheters?
- Use of a cuffed tunneled catheter
- Presence of femoral venous access site (Correct answer)
- Use of chlorhexidine-impregnated dressings
- Tip positioned at the cavoatrial junction
Correct answer: Presence of femoral venous access site
The femoral site carries a significantly higher CLABSI risk compared to subclavian or internal jugular sites due to proximity to the perineum and higher bacterial colonization.
Question 7: A pediatric patient's implanted port requires access. Which needle type must be used to access the port septum?
- Standard hypodermic needle
- Non-coring (Huber) needle (Correct answer)
- Butterfly needle
- Spinal needle
Correct answer: Non-coring (Huber) needle
A non-coring Huber needle must be used to access implanted ports; standard needles core the silicone septum and damage the port, leading to leakage.
VABC Pediatric Access 5
What is the primary reason chlorhexidine gluconate (CHG) skin antisepsis is used with caution in neonates under 2 months of age?