VA-BC CERTIFICATION STUDY GUIDE 2026 –
COMPLETE VASCULAR ACCESS REVIEW &
PREPARATION SUPPORT
1. A 68-year-old patient with a history of Stage IV breast cancer, bilateral mastectomies, and
axillary lymph node dissection requires a PICC for long-term antibiotic therapy. The most
appropriate initial action by the VA-BC professional is to:
A. Place a PICC in the right basilic vein.
B. Place a PICC in the left cephalic vein.
C. Perform a comprehensive pre-procedure vascular assessment, including history of surgeries.
D. Use a single-lumen PICC to minimize risk of infection.
Answer: C. Perform a comprehensive pre-procedure vascular assessment, including history of
surgeries.
Rationale: A history of mastectomy and lymph node dissection significantly increases the risk of
lymphedema if an IV device is placed on the affected side. A comprehensive assessment must
always precede any device selection or insertion to identify such contraindications and guide
safe vein selection.
2. Which of the following solutions is considered a vesicant?
A. 0.9% Sodium Chloride
B. 5% Dextrose in Water
C. Vancomycin
D. Total Parenteral Nutrition (TPN)
Answer: D. Total Parenteral Nutrition (TPN)
Rationale: TPN with a high dextrose concentration and amino acids is hyperosmolar and
considered a vesicant. Extravasation can cause severe tissue damage, necrosis, and sloughing.
Vancomycin can be an irritant, but TPN is a classic, high-risk vesicant.
3. The primary reason for selecting the right basilic vein as the first choice for PICC insertion
is:
A. It is the most comfortable for the patient.
B. It is the most superficial and easy to palpate.
C. It typically has the largest diameter and straightest path to the central vasculature.
D. It has the lowest number of valves.
,Answer: C. It typically has the largest diameter and straightest path to the central vasculature.
Rationale: The basilic vein is often the preferred site because it is usually the largest in
diameter, has the thinnest surrounding tissue, and follows a direct path through the axillary
vein, reducing the risk of malposition and facilitating optimal tip placement.
4. A physician orders a continuous infusion of 3% saline. The most appropriate vascular access
device for this infusion is:
A. A 22-gauge midline catheter.
B. A 24-gauge peripheral IV.
C. A power-injectable PICC.
D. A heparin-locked tunneled catheter.
Answer: C. A power-injectable PICC.
Rationale: 3% saline is hyperosmolar (>900 mOsm/L) and requires dilution in a large-diameter
vessel to prevent damage to the vessel intima. A PICC, with its tip terminating in the lower 1/3
of the SVC, is appropriate. A power-injectable designation ensures the device can handle the
pressure, though it's not required for the osmolarity alone. Midlines and peripheral IVs are
unsuitable for such solutions.
5. During a pre-insertion ultrasound assessment, a vein appears non-compressible, echogenic,
and lacks Doppler flow. This finding is most consistent with:
A. A healthy, patent vein.
B. Acute deep vein thrombosis (DVT).
C. Chronic venous insufficiency.
D. An artery.
Answer: B. Acute deep vein thrombosis (DVT).
Rationale: The classic ultrasound triad for acute DVT is non-compressibility, intraluminal
echogenicity (clot visible), and absence of flow. A healthy vein will be fully compressible. This
finding is an absolute contraindication to using that vein.
6. The minimum recommended catheter-to-vein ratio for peripheral IV placement to promote
hemodilution and reduce phlebitis risk is:
A. 25%
B. 45%
C. 66%
D. 90%
Answer: B. 45%
Rationale: The Infusion Nurses Society (INS) Standards of Practice recommend that the catheter
occupy no more than 45% of the vein's total lumen. This allows for adequate blood flow around
,the catheter, promoting hemodilution of the infusate and reducing the risk of mechanical and
chemical phlebitis.
7. A patient with end-stage renal disease and an arteriovenous (AV) fistula in the left upper
arm requires a central line for apheresis. The most appropriate action is to:
A. Place a PICC in the left upper arm, distal to the fistula.
B. Place a PICC in the right upper arm.
C. Use the AV fistula for the apheresis procedure.
D. Place a femoral venous catheter.
Answer: B. Place a PICC in the right upper arm.
Rationale: The limb with an AV fistula is protected. No venipuncture or blood pressure
measurement should be performed on that arm to preserve the fistula. The contralateral arm is
the preferred site. A femoral line is a less desirable option due to higher infection rates.
8. The primary advantage of a midline catheter over a peripheral IV is:
A. It can be used for central venous pressure monitoring.
B. It is suitable for infusing vesicant medications.
C. It has a longer dwell time, reducing the need for frequent re-starts.
D. It can be used for blood sampling indefinitely.
Answer: C. It has a longer dwell time, reducing the need for frequent re-starts.
Rationale: Midline catheters are designed for therapies lasting 1-4 weeks, whereas peripheral
IVs typically last for a few days. This longer dwell time is their key benefit. They are not central
lines and cannot be used for monitoring, vesicants, or long-term blood sampling.
9. When planning for a tunneled central venous catheter (e.g., Hickman), the VA-BC's role
primarily involves:
A. Surgically dissecting the tunnel.
B. Selecting the appropriate catheter type and size based on the patient's needs.
C. Managing the patient's general anesthesia.
D. Suture the exit site post-placement.
Answer: B. Selecting the appropriate catheter type and size based on the patient's needs.
Rationale: The VA-BC is an expert in device selection, considering factors like lumen number,
flow rates, and the intended therapy (e.g., chemotherapy, dialysis). The actual tunneling and
surgical placement are typically performed by a physician or advanced practitioner.
10. A key difference between a PICC and a non-tunneled central venous catheter (CVC) is:
A. A PICC is always a dual-lumen device.
B. A PICC is inserted in a peripheral location, while a non-tunneled CVC is inserted in a central
location (e.g., subclavian, jugular).
, C. A PICC requires a chest x-ray for tip confirmation, while a non-tunneled CVC does not.
D. A PICC cannot be used for power injection.
Answer: B. A PICC is inserted in a peripheral location, while a non-tunneled CVC is inserted in
a central location (e.g., subclavian, jugular).
Rationale: This is the fundamental definition. PICCs are defined by their insertion
site (peripheral) and terminal tip location (central). Non-tunneled CVCs are inserted directly into
a central vein.
VA-BC Certification Practice Questions (11-25): Insertion & Tip Confirmation
11. The gold standard for confirming PICC tip location is:
A. Transesophageal echocardiogram (TEE).
B. Electrocardiographic (ECG) tip confirmation.
C. Chest radiograph (CXR).
D. Ultrasound of the subclavian vein.
Answer: C. Chest radiograph (CXR).
Rationale: While ECG tip confirmation is a valuable real-time tool at the bedside, the CXR
remains the legally defensible "gold standard" for documenting final tip position in the lower
1/3 of the SVC, near the cavoatrial junction, and for ruling out complications like pneumothorax.
12. During ECG tip confirmation, the P-wave on the intravascular ECG tracing becomes
biphasic or diminishes in amplitude. This indicates the catheter tip is in the:
A. Superior Vena Cava (SVC).
B. Brachiocephalic Vein.
C. Right Atrium.
D. Inferior Vena Cava (IVC).
Answer: A. Superior Vena Cava (SVC).
Rationale: As the catheter tip advances into the SVC, the P-wave begins to change shape. A tall,
peaked P-wave is indicative of the right atrium. A biphasic or diminishing P-wave is the target,
indicating placement in the SVC, optimally in the lower third.
13. The maximum recommended dwell time for a peripheral intravenous catheter is:
A. 24 hours
B. 72-96 hours
C. 7 days
D. There is no recommended maximum; it should be replaced only when clinically indicated.
COMPLETE VASCULAR ACCESS REVIEW &
PREPARATION SUPPORT
1. A 68-year-old patient with a history of Stage IV breast cancer, bilateral mastectomies, and
axillary lymph node dissection requires a PICC for long-term antibiotic therapy. The most
appropriate initial action by the VA-BC professional is to:
A. Place a PICC in the right basilic vein.
B. Place a PICC in the left cephalic vein.
C. Perform a comprehensive pre-procedure vascular assessment, including history of surgeries.
D. Use a single-lumen PICC to minimize risk of infection.
Answer: C. Perform a comprehensive pre-procedure vascular assessment, including history of
surgeries.
Rationale: A history of mastectomy and lymph node dissection significantly increases the risk of
lymphedema if an IV device is placed on the affected side. A comprehensive assessment must
always precede any device selection or insertion to identify such contraindications and guide
safe vein selection.
2. Which of the following solutions is considered a vesicant?
A. 0.9% Sodium Chloride
B. 5% Dextrose in Water
C. Vancomycin
D. Total Parenteral Nutrition (TPN)
Answer: D. Total Parenteral Nutrition (TPN)
Rationale: TPN with a high dextrose concentration and amino acids is hyperosmolar and
considered a vesicant. Extravasation can cause severe tissue damage, necrosis, and sloughing.
Vancomycin can be an irritant, but TPN is a classic, high-risk vesicant.
3. The primary reason for selecting the right basilic vein as the first choice for PICC insertion
is:
A. It is the most comfortable for the patient.
B. It is the most superficial and easy to palpate.
C. It typically has the largest diameter and straightest path to the central vasculature.
D. It has the lowest number of valves.
,Answer: C. It typically has the largest diameter and straightest path to the central vasculature.
Rationale: The basilic vein is often the preferred site because it is usually the largest in
diameter, has the thinnest surrounding tissue, and follows a direct path through the axillary
vein, reducing the risk of malposition and facilitating optimal tip placement.
4. A physician orders a continuous infusion of 3% saline. The most appropriate vascular access
device for this infusion is:
A. A 22-gauge midline catheter.
B. A 24-gauge peripheral IV.
C. A power-injectable PICC.
D. A heparin-locked tunneled catheter.
Answer: C. A power-injectable PICC.
Rationale: 3% saline is hyperosmolar (>900 mOsm/L) and requires dilution in a large-diameter
vessel to prevent damage to the vessel intima. A PICC, with its tip terminating in the lower 1/3
of the SVC, is appropriate. A power-injectable designation ensures the device can handle the
pressure, though it's not required for the osmolarity alone. Midlines and peripheral IVs are
unsuitable for such solutions.
5. During a pre-insertion ultrasound assessment, a vein appears non-compressible, echogenic,
and lacks Doppler flow. This finding is most consistent with:
A. A healthy, patent vein.
B. Acute deep vein thrombosis (DVT).
C. Chronic venous insufficiency.
D. An artery.
Answer: B. Acute deep vein thrombosis (DVT).
Rationale: The classic ultrasound triad for acute DVT is non-compressibility, intraluminal
echogenicity (clot visible), and absence of flow. A healthy vein will be fully compressible. This
finding is an absolute contraindication to using that vein.
6. The minimum recommended catheter-to-vein ratio for peripheral IV placement to promote
hemodilution and reduce phlebitis risk is:
A. 25%
B. 45%
C. 66%
D. 90%
Answer: B. 45%
Rationale: The Infusion Nurses Society (INS) Standards of Practice recommend that the catheter
occupy no more than 45% of the vein's total lumen. This allows for adequate blood flow around
,the catheter, promoting hemodilution of the infusate and reducing the risk of mechanical and
chemical phlebitis.
7. A patient with end-stage renal disease and an arteriovenous (AV) fistula in the left upper
arm requires a central line for apheresis. The most appropriate action is to:
A. Place a PICC in the left upper arm, distal to the fistula.
B. Place a PICC in the right upper arm.
C. Use the AV fistula for the apheresis procedure.
D. Place a femoral venous catheter.
Answer: B. Place a PICC in the right upper arm.
Rationale: The limb with an AV fistula is protected. No venipuncture or blood pressure
measurement should be performed on that arm to preserve the fistula. The contralateral arm is
the preferred site. A femoral line is a less desirable option due to higher infection rates.
8. The primary advantage of a midline catheter over a peripheral IV is:
A. It can be used for central venous pressure monitoring.
B. It is suitable for infusing vesicant medications.
C. It has a longer dwell time, reducing the need for frequent re-starts.
D. It can be used for blood sampling indefinitely.
Answer: C. It has a longer dwell time, reducing the need for frequent re-starts.
Rationale: Midline catheters are designed for therapies lasting 1-4 weeks, whereas peripheral
IVs typically last for a few days. This longer dwell time is their key benefit. They are not central
lines and cannot be used for monitoring, vesicants, or long-term blood sampling.
9. When planning for a tunneled central venous catheter (e.g., Hickman), the VA-BC's role
primarily involves:
A. Surgically dissecting the tunnel.
B. Selecting the appropriate catheter type and size based on the patient's needs.
C. Managing the patient's general anesthesia.
D. Suture the exit site post-placement.
Answer: B. Selecting the appropriate catheter type and size based on the patient's needs.
Rationale: The VA-BC is an expert in device selection, considering factors like lumen number,
flow rates, and the intended therapy (e.g., chemotherapy, dialysis). The actual tunneling and
surgical placement are typically performed by a physician or advanced practitioner.
10. A key difference between a PICC and a non-tunneled central venous catheter (CVC) is:
A. A PICC is always a dual-lumen device.
B. A PICC is inserted in a peripheral location, while a non-tunneled CVC is inserted in a central
location (e.g., subclavian, jugular).
, C. A PICC requires a chest x-ray for tip confirmation, while a non-tunneled CVC does not.
D. A PICC cannot be used for power injection.
Answer: B. A PICC is inserted in a peripheral location, while a non-tunneled CVC is inserted in
a central location (e.g., subclavian, jugular).
Rationale: This is the fundamental definition. PICCs are defined by their insertion
site (peripheral) and terminal tip location (central). Non-tunneled CVCs are inserted directly into
a central vein.
VA-BC Certification Practice Questions (11-25): Insertion & Tip Confirmation
11. The gold standard for confirming PICC tip location is:
A. Transesophageal echocardiogram (TEE).
B. Electrocardiographic (ECG) tip confirmation.
C. Chest radiograph (CXR).
D. Ultrasound of the subclavian vein.
Answer: C. Chest radiograph (CXR).
Rationale: While ECG tip confirmation is a valuable real-time tool at the bedside, the CXR
remains the legally defensible "gold standard" for documenting final tip position in the lower
1/3 of the SVC, near the cavoatrial junction, and for ruling out complications like pneumothorax.
12. During ECG tip confirmation, the P-wave on the intravascular ECG tracing becomes
biphasic or diminishes in amplitude. This indicates the catheter tip is in the:
A. Superior Vena Cava (SVC).
B. Brachiocephalic Vein.
C. Right Atrium.
D. Inferior Vena Cava (IVC).
Answer: A. Superior Vena Cava (SVC).
Rationale: As the catheter tip advances into the SVC, the P-wave begins to change shape. A tall,
peaked P-wave is indicative of the right atrium. A biphasic or diminishing P-wave is the target,
indicating placement in the SVC, optimally in the lower third.
13. The maximum recommended dwell time for a peripheral intravenous catheter is:
A. 24 hours
B. 72-96 hours
C. 7 days
D. There is no recommended maximum; it should be replaced only when clinically indicated.
