VABC : COMPLICATIONS AND
INTERVENTIONS UPDATED ACTUAL
Exam Questions and CORRECT Answers
COMP/INTER : GENERAL CONSIDERATIONS - CORRECT ANSWER - A thorough
understanding of vascular anatomy, device placement, device-specific issues, patient-specific
issues, and potential complications provides the foundation for vascular access specialists to
troubleshoot and problem-solve.
-Prevention of common complications is critical; prevention strategies applicable across the
continuum of care must be employed.
-Educate and validate competency (both initially and annually) for all personnel involved in the
insertion, use, and/or maintenance of vascular access devices.
-Peer-reviewed, published, and evidence-based education and practices must be provided and
systematic approaches to problem-solving must be employed for staff, patients, and caregivers.
*Development of critical thinking skills around vascular access must be supported for all
clinicians involved in the insertion, use, and maintenance of vascular access devices*
COMP/INTER : PERI-INSERTION CVAD MALPOSITION - CORRECT ANSWER -
Difficulty advancing the catheter requiring the insertion to troubleshoot possible causes and
employ various techniques to obtain optimal catheter tip position.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION CAUSES - CORRECT
ANSWER - -Damage from previous surgical procedures, accidents, or trauma to related
vessels
-Repeated prior catheterizations
-Inappropriate catheter-to-vessel ratio
-Venospasm
-Aberrant vasculature
-Stenosis/thrombosis
,-Pacemaker
-Automatic implantable cardioverter defibrillator
COMP/INTER : PERI-INSERTION CVAD MALPOSITION PREVENTION PT 1 - CORRECT
ANSWER - Review medical history for aberrant vasculature, history of venous
thrombosis, or difficult catheter insertion.
Comprehensive pre-scan with ultrasound and use of tip navigation system
Accurate pre-measurement of external anatomical landmarks
Avoid stenotic or thrombotic vessels
Use of real-time ultrasound of the ipsilateral jugular to rule out jugular malposition if tip
navigation is unavailable.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION PREVENTION PT 2 - CORRECT
ANSWER - Assess for anxiety and consider administration of anxiolytic, relaxation
techniques, and/or sedation
If possible and clinically appropriate, ensure the patient is well hydrated.
Employ vasodilation techniques such as warm compress/blanket
Select a catheter size that can be appropriately accommodated by the vein size.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION SYMPTOMS - CORRECT
ANSWER - Unable to advance catheter/meet with resistance during advancement
attempts.
,Patient reports hearing flushing sound when CVAD is flushed. difficulty flushing catheter, and/or
reports pain or discomfort with catheter advancement.
Blood flow is diminished or absent with certain positions
Difficulty removing guidewire and/or it appears bent when removed
COMP/INTER : PERI-INSERTION CVAD MALPOSITION TREATMENT - CORRECT
ANSWER - -Pull the catheter back slightly and redirect
-For malposition in the ipsilateral jugular, rapid flushing with 0.9% normal saline during the
insertion procedure may cause some smaller bore catheters to reposition appropriately.
-During PICC and axillary insertion having the patient turn their head and adjust their chin to the
shoulder on the ipsilateral side may deter the catheter from advancing to the internal jugular and
allow the catheter to advance.
-Softening the tip of the catheter by removing/pulling back the guidewire/stylet and slowly
advancing may allow the catheter to advance.
*Consider repositioning the patient's arm or referral to interventional radiology*
COMP/INTER : POST-INSERTION TIP MALPOSITION - CORRECT ANSWER -
Migration of catheter tip after CVAD has been released for use; can occur within hours after
confirmed placement or throughout catheter dwell time (days, weeks, months, year later).
COMP/INTER : POST-INSERTION TIP MALPOSITION CAUSES - CORRECT
ANSWER - Sudden increase in intra-thoracic pressure such as during coughing or
vomiting.
Increased central venous pressures related to congestive heart failure or pulmonary hypertension.
Inadequate catheter stabilization at the exit site
Forceful flushing
, Excessive exercise
Catheter erosion into extra-vascular space or catheter tip migration into mid or upper SVC
Pressure injection on contrast
COMP/INTER : POST-INSERTION TIP MALPOSITION PREVENTION - CORRECT
ANSWER - Optimal tip placement at the upper right atrium/CAJ or in the lower one-third
of the SVC at insertion
Appropriate stabilization and proper dressing management
Daily assessment of CVAD and patient condition
COMP/INTER : POST-INSERTION TIP MALPOSITION SYMPTOMS - CORRECT
ANSWER - May be asymptomatic however other symptoms include
The patient reports hearing a flushing sound when CVAD is flushed
Blood flow is diminished or absent in certain positions
Chest Xray reveals mal-position
Arrhythmia, chest pain, dyspnea, hypotension
Prolonged malposition may lead to dysfunctional catheter, venous, thrombosis, or vessel erosion.
COMP/INTER : POST-INSERTION TIP MALPOSITION TREATMENT - CORRECT
ANSWER - Notify licensed independent practitioner
INTERVENTIONS UPDATED ACTUAL
Exam Questions and CORRECT Answers
COMP/INTER : GENERAL CONSIDERATIONS - CORRECT ANSWER - A thorough
understanding of vascular anatomy, device placement, device-specific issues, patient-specific
issues, and potential complications provides the foundation for vascular access specialists to
troubleshoot and problem-solve.
-Prevention of common complications is critical; prevention strategies applicable across the
continuum of care must be employed.
-Educate and validate competency (both initially and annually) for all personnel involved in the
insertion, use, and/or maintenance of vascular access devices.
-Peer-reviewed, published, and evidence-based education and practices must be provided and
systematic approaches to problem-solving must be employed for staff, patients, and caregivers.
*Development of critical thinking skills around vascular access must be supported for all
clinicians involved in the insertion, use, and maintenance of vascular access devices*
COMP/INTER : PERI-INSERTION CVAD MALPOSITION - CORRECT ANSWER -
Difficulty advancing the catheter requiring the insertion to troubleshoot possible causes and
employ various techniques to obtain optimal catheter tip position.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION CAUSES - CORRECT
ANSWER - -Damage from previous surgical procedures, accidents, or trauma to related
vessels
-Repeated prior catheterizations
-Inappropriate catheter-to-vessel ratio
-Venospasm
-Aberrant vasculature
-Stenosis/thrombosis
,-Pacemaker
-Automatic implantable cardioverter defibrillator
COMP/INTER : PERI-INSERTION CVAD MALPOSITION PREVENTION PT 1 - CORRECT
ANSWER - Review medical history for aberrant vasculature, history of venous
thrombosis, or difficult catheter insertion.
Comprehensive pre-scan with ultrasound and use of tip navigation system
Accurate pre-measurement of external anatomical landmarks
Avoid stenotic or thrombotic vessels
Use of real-time ultrasound of the ipsilateral jugular to rule out jugular malposition if tip
navigation is unavailable.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION PREVENTION PT 2 - CORRECT
ANSWER - Assess for anxiety and consider administration of anxiolytic, relaxation
techniques, and/or sedation
If possible and clinically appropriate, ensure the patient is well hydrated.
Employ vasodilation techniques such as warm compress/blanket
Select a catheter size that can be appropriately accommodated by the vein size.
COMP/INTER : PERI-INSERTION CVAD MALPOSITION SYMPTOMS - CORRECT
ANSWER - Unable to advance catheter/meet with resistance during advancement
attempts.
,Patient reports hearing flushing sound when CVAD is flushed. difficulty flushing catheter, and/or
reports pain or discomfort with catheter advancement.
Blood flow is diminished or absent with certain positions
Difficulty removing guidewire and/or it appears bent when removed
COMP/INTER : PERI-INSERTION CVAD MALPOSITION TREATMENT - CORRECT
ANSWER - -Pull the catheter back slightly and redirect
-For malposition in the ipsilateral jugular, rapid flushing with 0.9% normal saline during the
insertion procedure may cause some smaller bore catheters to reposition appropriately.
-During PICC and axillary insertion having the patient turn their head and adjust their chin to the
shoulder on the ipsilateral side may deter the catheter from advancing to the internal jugular and
allow the catheter to advance.
-Softening the tip of the catheter by removing/pulling back the guidewire/stylet and slowly
advancing may allow the catheter to advance.
*Consider repositioning the patient's arm or referral to interventional radiology*
COMP/INTER : POST-INSERTION TIP MALPOSITION - CORRECT ANSWER -
Migration of catheter tip after CVAD has been released for use; can occur within hours after
confirmed placement or throughout catheter dwell time (days, weeks, months, year later).
COMP/INTER : POST-INSERTION TIP MALPOSITION CAUSES - CORRECT
ANSWER - Sudden increase in intra-thoracic pressure such as during coughing or
vomiting.
Increased central venous pressures related to congestive heart failure or pulmonary hypertension.
Inadequate catheter stabilization at the exit site
Forceful flushing
, Excessive exercise
Catheter erosion into extra-vascular space or catheter tip migration into mid or upper SVC
Pressure injection on contrast
COMP/INTER : POST-INSERTION TIP MALPOSITION PREVENTION - CORRECT
ANSWER - Optimal tip placement at the upper right atrium/CAJ or in the lower one-third
of the SVC at insertion
Appropriate stabilization and proper dressing management
Daily assessment of CVAD and patient condition
COMP/INTER : POST-INSERTION TIP MALPOSITION SYMPTOMS - CORRECT
ANSWER - May be asymptomatic however other symptoms include
The patient reports hearing a flushing sound when CVAD is flushed
Blood flow is diminished or absent in certain positions
Chest Xray reveals mal-position
Arrhythmia, chest pain, dyspnea, hypotension
Prolonged malposition may lead to dysfunctional catheter, venous, thrombosis, or vessel erosion.
COMP/INTER : POST-INSERTION TIP MALPOSITION TREATMENT - CORRECT
ANSWER - Notify licensed independent practitioner
