VA-BC CERTIFICATION / VA-BC EXAMS / VA-BC STUDY GUIDE 2023 -2024 ACTUAL EXAM 400 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES |ALREADY GRADED A+ What are the contraindications for non -tunneled catheters? - ANSWER - Neck or chest sites may be excluded for patients with tracheostomies, radical neck dissection, and cervical fracture instability, or unstable airway Inability to position patient, insert or stabilize catheter Avoid insertion on same side as a PICC that passes through the subclavian vein What are the potential vessels for non -tunneled catheters? - ANSWER - A. Jugular veins, external and/or internal B. Subclavian veins C. Femoral veins (least preferred) In patients at greater risk for catheter associated bloodstream infections (CABSI) what typed of PICC or non -tunneled catheters should be considered? - ANSWER - Anti-microbial catheters What type of barrier precautions are required for non -tunneled catheter placement? - ANSWER - Maximun sterile How should a patient be positioned for non -tunneled catheter placement? - ANSWER - slight Trendelenburg position Why is a patient placed in slight Trendelenburg position for non -
tunneled catheter placement? - ANSWER - to avoid the possibility of air emboli during the placement procedure In non -tunneled catheter or PICC placement., what should always be avoided when accessing veins? - ANSWER - Blind -stick attempts. Prior to any infusion of non -tunneled catheters, how should tip location be confirmed? - ANSWER - ECG technology or radiograph What must be obtained prior to ANY infusion of a non -tunneled catheter or a PICC line? - ANSWER - A free flowing blood return What is the optimal tip location for a non -tunneled and PICC catheters? - ANSWER - Cavoatrial juncture (CAJ) If inserted through the femoral vein, what the optimal tip location for a non-tunneled and PICC catheters? - ANSWER - Inferior vena cava (IVC) above the level of the diaphragm Why is the femoral vein is commonly used in pediatric critical care units for non -tunneled catheter placement? - ANSWER - Due to ease of insertion in young patients Why may the jugular vein be the preferred point of insertion in very young children for non -tunneled catheters? - ANSWER - To avoid a pneumothorax What are the indications for placement of a PICC line? - ANSWER - -
Patients who require central venous access when the duration of the infusions are unknown -Infusion of irritating medications -Infusion of vesicant agents What are the contraindications of PICC line placement? - ANSWER - -
Placement into an arm with fracture, trauma, infection, amputations, or compromised circulation -Placement into an arm paralyzed as a result of a CVA may increase the risk of catheter -related thrombosis due to compromised circulation 4 -Chronic kidney disease patients What vessels are selected for PICC line placement? - ANSWER - Basilic, brachial or cephalic vein in the upper arm What barrier precautions are required for PICC placement? - ANSWER - Maximum sterile What areas of tip location should be avoided in PICC line placement? - ANSWER - Avoid catheter tip locations in the upper SVC or midclavicular areas What Alternative veins for PICC lines may be selected in pediatric pts.? - ANSWER - Scalp veins, popliteal veins In pediatric patients, what, if added ,may decrease catheter occlusion? - ANSWER - Heparin (confirm infusatn compatibility) What are the indications for tunneled catheters? - ANSWER - -Infusions that are projected to continue for months or years -Apheresis What are the contraindications for tunneled catheter placement? - ANSWER - -Presence of a bloodstream infection -Severe coagulopathy
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