VABC Complication Management 4 — Questions and Answers
Question 1: Which of the following dressing changes is recommended by the CDC for central venous catheters to reduce CRBSI risk?
- Gauze dressing changed every 48 hours or transparent semi-permeable dressing changed every 7 days (Correct answer)
- Daily dressing changes regardless of dressing type
- Dressing changed only when visibly soiled or loose
- Antimicrobial-impregnated dressing changed every 3 days
Correct answer: Gauze dressing changed every 48 hours or transparent semi-permeable dressing changed every 7 days
CDC guidelines recommend gauze dressings every 48 hours or transparent semi-permeable dressings every 7 days (or sooner if soiled, loosened, or visibly contaminated).
Question 2: A patient's implanted port cannot be de-accessed because the needle is stuck in the septum. What is the most appropriate initial step?
- Apply traction and forcefully pull the needle out
- Rotate the needle 90 degrees while applying gentle outward pressure (Correct answer)
- Leave the needle in place and consult interventional radiology
- Inject saline to loosen the needle from the septum
Correct answer: Rotate the needle 90 degrees while applying gentle outward pressure
A gentle rotational motion while applying steady outward traction can release a huber needle stuck in the port septum without damaging the septum or surrounding tissue.
Question 3: In the setting of CRBSI with Staphylococcus aureus, what is the minimum recommended duration of systemic antibiotic therapy when the catheter is removed?
- 7 days
- 14 days (Correct answer)
- At least 4-6 weeks
- 10-14 days only if no evidence of metastatic infection
Correct answer: 14 days
S. aureus CRBSI requires at least 14 days of systemic antibiotics after catheter removal to reduce the risk of endocarditis and metastatic infection.
Question 4: A patient with a dialysis catheter develops recurrent CRBSI despite appropriate antibiotic therapy. Which preventive strategy is recommended to preserve catheter salvage?
- Continuous systemic antibiotic prophylaxis
- Antibiotic lock therapy between dialysis sessions (Correct answer)
- Daily chlorhexidine hub disinfection caps
- Routine catheter exchange over a guidewire every 30 days
Correct answer: Antibiotic lock therapy between dialysis sessions
Antibiotic lock therapy, instilling high-concentration antibiotics into the catheter lumen between sessions, is evidence-based for preventing recurrent CRBSI in dialysis catheters.
Question 5: What is the first step when a vascular access nurse suspects a catheter-associated deep vein thrombosis (CA-DVT)?
- Remove the catheter immediately
- Order compression ultrasound of the affected extremity (Correct answer)
- Start anticoagulation empirically without imaging
- Reassess in 24 hours if symptoms are mild
Correct answer: Order compression ultrasound of the affected extremity
Compression ultrasound is the diagnostic gold standard for upper or lower extremity DVT and should be obtained before treatment decisions are made.
Question 6: A patient receiving continuous IV infusion through a PICC has an infusion pump alarm indicating high resistance. The PICC flushes with difficulty but no swelling is noted. What is the most likely cause?
- Air embolism occluding the distal catheter tip
- Positional occlusion or kinking of the catheter (Correct answer)
- Complete fibrin sheath occlusion
- Tip migration into the right ventricle
Correct answer: Positional occlusion or kinking of the catheter
Positional occlusion (catheter kinking with arm position changes) is a common cause of intermittent high resistance alarms without extravasation signs.
Question 7: Which anatomical landmark determines correct PICC tip placement in adult patients per AVA and INS guidelines?
- Mid-subclavian vein
- Junction of the superior vena cava and right atrium (cavoatrial junction) (Correct answer)
- Proximal axillary vein
- Lower third of the superior vena cava above the carina
Correct answer: Junction of the superior vena cava and right atrium (cavoatrial junction)
The cavoatrial junction (CAJ) is the recommended optimal tip position per AVA and INS, ensuring high-flow dilution of infusates and reducing thrombosis risk.
VABC Complication Management 4
Which of the following dressing changes is recommended by the CDC for central venous catheters to reduce CRBSI risk?