VA-BC Patient Evaluation & Care Coordination 5 — Questions and Answers
Question 1: A multidisciplinary team is discussing vascular access for a patient admitted with septic shock who needs vasopressors, fluids, and blood draws simultaneously. Which device is most appropriate?
- Two peripheral IV catheters in separate sites
- Multi-lumen central venous catheter (Correct answer)
- Single-lumen PICC line
- Midline catheter in the upper arm
Correct answer: Multi-lumen central venous catheter
A multi-lumen CVC provides simultaneous administration of incompatible medications (vasopressors), fluids, and blood sampling without the limitations of peripheral or single-lumen access in critical illness.
Question 2: A vascular access nurse is called to evaluate a patient who has had three failed peripheral IV attempts by floor nurses. On assessment, the nurse finds no suitable peripheral veins but the patient needs only a 3-day course of IV antibiotics. What is the most appropriate recommendation?
- Insert a PICC line for the 3-day course
- Attempt ultrasound-guided peripheral IV insertion before escalating to a PICC (Correct answer)
- Place a tunneled CVC for reliable access
- Recommend oral antibiotics to avoid invasive access
Correct answer: Attempt ultrasound-guided peripheral IV insertion before escalating to a PICC
For a short-term need, ultrasound-guided peripheral IV insertion should be attempted before escalating to a PICC, following the Infusion Nurses Society's vascular access device selection algorithm.
Question 3: While reviewing a patient's chart before PICC insertion, the nurse notes the patient has an AV fistula in the left arm and a history of right-sided breast cancer with axillary lymph node dissection. Where should the PICC be placed?
- Left arm, above the AV fistula to avoid affecting it
- Right arm, avoiding the compromised lymphatic drainage side
- Either arm is acceptable if the vein is patent
- Femoral approach, avoiding both arms (Correct answer)
Correct answer: Femoral approach, avoiding both arms
Both arms are contraindicated (left: AV fistula, right: lymph node dissection with lymphedema risk), so an alternative approach such as femoral or jugular access with provider collaboration is required.
Question 4: A vascular access nurse completes a PICC insertion and obtains a post-insertion chest X-ray. The radiologist reports the tip is in the right atrium. What is the correct next action?
- Begin the prescribed infusion as the right atrium is an acceptable tip location
- Withdraw the catheter by the estimated number of centimeters to reposition the tip at the cavoatrial junction (Correct answer)
- Remove the PICC and place a new one
- Flush with 20 mL of normal saline to push the tip into proper position
Correct answer: Withdraw the catheter by the estimated number of centimeters to reposition the tip at the cavoatrial junction
A tip in the right atrium must be withdrawn to the cavoatrial junction per standards, as right atrial placement increases the risk of arrhythmias and cardiac perforation.
Question 5: In the context of vascular access care coordination, which action best demonstrates the nurse's role as a patient advocate?
- Placing the device ordered without question to maintain efficiency
- Educating the patient about the risks and benefits of different access options and incorporating their preferences into the care plan (Correct answer)
- Delegating patient education to the bedside nurse
- Choosing the device that is most convenient for nursing staff to manage
Correct answer: Educating the patient about the risks and benefits of different access options and incorporating their preferences into the care plan
Patient advocacy in vascular access includes ensuring informed decision-making by educating patients about their options, risks, and benefits, and incorporating their preferences into the care plan.
Question 6: A patient with an implanted port reports inability to aspirate blood or infuse fluids during a scheduled chemotherapy visit. After verifying needle placement in the port, what is the next appropriate assessment step?
- Remove the port needle and attempt re-access with a new non-coring needle
- Have the patient change positions (raise arms, cough, or turn their head) and retry aspiration (Correct answer)
- Administer a thrombolytic agent immediately
- Discontinue the chemotherapy session and schedule a chest X-ray
Correct answer: Have the patient change positions (raise arms, cough, or turn their head) and retry aspiration
Positional changes can relieve tip malposition against the vessel wall (positional occlusion), and this simple maneuver should be attempted before escalating to thrombolytics or imaging.
Question 7: A nurse performing a comprehensive vascular access assessment uses the mnemonic 'DIVA' (Difficult Intravenous Access). Which patient characteristic is included in validated DIVA scoring tools?
- Patient's pain tolerance level
- Vein visibility and palpability on tourniquet application (Correct answer)
- Patient's preference for left versus right arm
- Time since last oral intake
Correct answer: Vein visibility and palpability on tourniquet application
Validated DIVA assessment tools score vein visibility and palpability under tourniquet, along with history of difficult access and other anatomical factors, to predict IV insertion difficulty.
VA-BC Patient Evaluation & Care Coordination 5
A multidisciplinary team is discussing vascular access for a patient admitted with septic shock who needs vasopressors, fluids, and blood draws simultaneously.
Which device is most appropriate?