VA-BC CERTIFICATIONS STUDY MATERIAL QUESTIONS WITH 100% COMPLETE SOLUTIONS

VA-BC CERTIFICATIONS STUDY MATERIAL QUESTIONS WITH 100% COMPLETE SOLUTIONS List indications for Vascular Access: - ANSWER-1. Total parenteral nutrition (TPN) 2. Partial parenteral nutrition 3. I.V. fluids and medications 4. Blood and blood components 5. Chemotherapeutic agents 6. Cardiac monitoring 7. Plasmapheresis 8. Aquapherisis 9. Haemodialysis a. Diagnostic testing b. Frequent blood sampling What is the French Scale? - ANSWER-Measurement of the outside size (diameter) of a catheter What is the range of Central venous catheter French sizes? - ANSWER-1.2fr for Neonates up to 15fr for dialysis catheters As the French size increases, what does the diameter of the catheter do? - ANSWER-It increases What is the gauge scale? - ANSWER-Measurement of the outside size(diameter) of a catheter As the gauge number gets larger, what happens to the catheter size? - ANSWER-It gets smaller. What is the gauge range of IV catheters? - ANSWER-24ga to 12 ga Why are all I.V. devices manufactured in the USA are required to be radiopaque? - ANSWER-To facilitate location of catheter emboli in the event of shearing or fracture From what two materials are IV catheters made? - ANSWER-Silicone and Polyurethane Which catheter material can be affected by alcohol? - ANSWER-Polyurethane What are the indications for short peripheral catheters? - ANSWER--Infusions projected for 6 days or less -Non-irritating medications and solutions -Non-vesicant medications and solutions What are contraindications for short peripheral catheters? - ANSWER--Placement into an arm with fracture, trauma, infection, or compromised circulation -Veins in the arm on the same side of a mastectomy, breast surgery or lymph node dissection -Veins in the arm with an A/V fistula or graft What veins are used for short peripheral catheters? - ANSWER-Metacarpal, cephalic, basilic and accessory veins of the arms How many short peripheral catheter insertion attempts per healthcare provider are allowed? - ANSWER-2 What additional veins in paediatrics may be used for non-irritating/non-vesicant infusions? - ANSWER-Metacarpal, cephalic or basilic, scalp veins if <18mo What are the indications for a midline catheter? - ANSWER--Infusions projected for 6 days- 4 weeks -Non-irritating medications and solutions -Non-vesicant medications and solutions What are contraindications for a midline? - ANSWER--Arms with: A/V fistula, infection, fracture, trauma, or compromised circulation -Chronic Kidney Disease What are the sites and vessel selection for midline catheters? - ANSWER-Basilic or cephalic vein in the antecubital fossa or lower part of the upper arm What product should be used for a midline placement? - ANSWER-A product that is specifically designed and labelled as a peripheral midline catheter What barrier precautions should be considered for midline placement? - ANSWER-Maximum sterile barrier Why should a PICC device NOT be used for midline placement? - ANSWER-Using a PICC device for midline placement will risk confusion related to the type of access device a patient has; places the catheter tip outside the SVC, which is contrary to the manufacturers' DFU related to the intention of the product and risks potential liability for the nurse. What is optimal tip location for a midline catheter? - ANSWER-One inch below the axillary area For midline placement, what alternative veins can be considered in pediatric patients? - ANSWER-Scalp veins Popliteal veins Saphenous veins What are the indications for non-tunneled catheters? - ANSWER-Short term central vein access Emergency central vein access 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-tunnelled catheters should be considered? - ANSWER-Anti-microbial catheters What type of barrier precautions are required for non-tunneled catheter placement? - ANSWER-Maximum 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-tunnelled catheter placement? - ANSWER-to avoid the possibility of air emboli during the placement procedure In non-tunnelled catheter or PICC placement., what should always be avoided when accessing veins? - ANSWER-Blind-stick attempts. Prior to any infusion of non-tunnelled catheters, how should tip location be confirmed? - ANSWER-ECG technology or radiograph What must be obtained prior to ANY infusion of a non-tunnelled catheter or a PICC line? - ANSWER-A free flowing blood return What is the optimal tip location for a non-tunnelled and PICC catheters? - ANSWER-Cavo atrial juncture (CAJ) If inserted through the femoral vein, what the optimal tip location for a non-tunnelled and PICC catheters? - ANSWER-Inferior vena cava (IVC) above the level of the diaphragm Why is the femoral vein is commonly used in paediatric critical care units for non-tunnelled 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-tunnelled 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