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Cheat sheet

VA-BC Cheat Sheet

Practice QuestionsStudy Guide

Patient Assessment

18%of exam

Vessel SelectionRisk ReviewUltrasound AssessmentAnatomy Path

Troubleshooting Complications

16%of exam

Occlusion PickerPhlebitis ScaleAir EmbolismExtravasation

Device Selection

14%of exam

Device PickerMAGICSAVE-CVADDialysis Preservation

Care Maintenance

14%of exam

Dressing IntervalsHub DisinfectionFlushingCLABSI Prevention

Insertion

11%of exam

Tip ConfirmationMST SequenceUltrasoundSecurement

Preparation

11%of exam

MSB BundleCHG PrepConsentPositioning

Professional Development

8%of exam

EBPQuality ImprovementINS StandardsRecertification

Legal Ethical

8%of exam

ScopeDocumentationHIPAAPatient Autonomy

Quick Facts

Exam
VA-BC
Body
VACC
Format
150 MCQ
Scored
125 items
Time
2.5 hr
Pass
Scaled 90
Window
June/December
Provider
Prometric
Validity
3 years
Blueprint
2025 Job Analysis

Vein Route

B-B-A-S-B-S-RA

Basilic/brachialAxillarySubclavianBrachiocephalicSVCRight atrium

Basilic vs Cephalic

Basilic

  • Larger vessel
  • Straighter path
  • Common target

Cephalic

  • Sharp shoulder curve
  • Advancement issues
  • Higher failure

Straight beats curved

Vascular Anatomy

Basilic
Large straight target
Cephalic
Curves near shoulder
Brachial
Near artery nerves
Axillary
Upper arm drainage
Subclavian
Pinch-off risk
Brachiocephalic
Feeds SVC
SVC
Upper body return
CAJ
Target tip zone

Assessment Risks

CKD
Preserve future access
Lymphedema
Avoid affected arm
Coags
Bleeding risk
Allergy
Substitute products
Edema
Poor site choice
Skin breakdown
Infection risk
History
Prior failures matter
Mobility
Protect dwell time

Occlusion Meds

Clot tPA; lipid ethanol; drug pH

tPA: thrombusEthanol: lipidHCl: alkalineNaHCO3: acidic

Mechanical vs Thrombotic

Mechanical

  • Kink clamp position
  • Reposition first
  • No tPA first

Thrombotic

  • Blood clot
  • Alteplase helps
  • Aspirate after dwell

Fix cause first

Occlusion Picker

  1. Line kinked→Reposition(Mechanical)
  2. No blood return→Assess sheath(Ball valve)
  3. Thrombotic occlusion→Alteplase(Per protocol)
  4. TPN lipid clot→Ethanol(Pharmacy protocol)
  5. Drug precipitate→HCl/NaHCO3(Match pH)
  6. Forced flush needed→Stop(Assess first)

Occlusion Types

Mechanical
Kink clamp position
Thrombotic
Blood clot
Fibrin tail
Withdrawal occlusion
Lipid
TPN residue
Drug precipitate
pH incompatibility
Alteplase
Thrombotic clearance
Ethanol
Lipid clearance
HCl/NaHCO3
Drug precipitate

Infiltration vs Extravasation

Infiltration

  • Nonvesicant leak
  • Cool swelling
  • Usually supportive

Extravasation

  • Vesicant leak
  • Tissue injury
  • Urgent protocol

Drug harm decides

Complication Signs

Phlebitis 1
Erythema possible pain
Phlebitis 2
Pain erythema edema
Phlebitis 3
Streak with cord
Phlebitis 4
Purulence or long cord
Infiltration
Nonvesicant leakage
Extravasation
Vesicant leakage
Air embolism
Dyspnea hypotension murmur
DVT
Swelling warmth pain

Device Duration

Days PIV, weeks midline, months central

PIV: briefMidline: intermediatePICC: centralPort: intermittent

Midline vs PICC

Midline

  • Peripheral tip
  • No vesicants
  • Intermediate dwell

PICC

  • Central tip
  • Vesicants allowed
  • Longer therapy

Peripheral vs central

Device Picker

  1. Brief peripheral therapy→PIV(Least invasive)
  2. One-four weeks→Midline(Peripheral infusate)
  3. Central infusate→PICC(CAJ tip)
  4. Frequent long-term→Tunneled CVC(External access)
  5. Intermittent long-term→Port(Under skin)
  6. Future dialysis→Avoid PICC(Preserve veins)
  7. Emergent access→IO(Temporary bridge)
  8. Dialysis bridge→Tunneled HD(Cuffed catheter)

Device Basics

Short PIV
Brief peripheral therapy
Midline
Peripheral longer dwell
PICC
Central upper-arm catheter
Tunneled CVC
Frequent long-term access
Port
Intermittent long-term access
HD catheter
Dialysis bridge
IO
Emergency temporary access
Arterial line
Pressure sampling

Selection Rules

MAGIC
Appropriateness guide
SAVE-CVAD
Preserve veins
Ratio
<=45% for PICC
Vesicant
Central access
Osmolality
Check central need
Lumens
Use fewest needed
Gauge
Smallest effective size
Duration
Drives device type

CLABSI vs CRBSI

CLABSI

  • Surveillance definition
  • May overcount
  • Quality metric

CRBSI

  • Clinical diagnosis
  • Line source proven
  • DTP supports

Metric vs diagnosis

Infection Picker

  1. Fever with line→Paired cultures(Check DTP)
  2. DTP over 2 hr→CRBSI likely(Same organism)
  3. Site purulence→Remove device(Notify provider)
  4. Vesicant burn→Stop infusion(Aspirate)
  5. Air symptoms→Left lateral(Trendelenburg)
  6. PICC arm swelling→Duplex US(DVT workup)

Maintenance Rules

TSM
Change 5-7 days
Gauze
Change 48 hours
Scrub hub
Friction before access
Pulsatile flush
Start-stop turbulence
Positive pressure
Reduces reflux
Connector
Change with sets
SSD
Sutureless securement
Site check
Assess each shift

TSM vs Gauze

TSM

  • Visual assessment
  • 5-7 days
  • Transparent barrier

Gauze

  • Hides insertion site
  • 48 hours
  • Drainage choice

Visible lasts longer

Infection Cues

CLABSI
Surveillance infection
CRBSI
Clinical line source
DTP
Central earlier positive
CoNS
Common pathogen
Biofilm
Intraluminal reservoir
CHG bathing
Maintenance bundle
Hub scrub
Prevents inoculation
Purulence
Remove assess culture

ECG vs Sherlock

ECG

  • Physiologic tip cue
  • P-wave rises
  • Final confirmation

Sherlock

  • Magnetic navigation
  • Tracks direction
  • Not final alone

Confirm vs navigate

Tip Picker

  1. Need vessel map→Ultrasound(Depth diameter)
  2. Need PICC path→Sherlock(Magnetic tracking)
  3. Need final tip→ECG(P-wave rise)
  4. ECG unreliable→CXR(Confirm location)
  5. Shoulder resistance→Reposition(Check malposition)
  6. Central insertion→MSB(CLABSI prevention)

Insertion Tools

MST
Needle wire dilator
Ultrasound
Real-time vessel view
Guidewire
Maintains vessel access
Dilator
Prepares tissue tract
ECG
P-wave tip cue
Sherlock
Magnetic tracking
CXR
Radiographic confirmation
Securement
Prevents migration

Sterile Bundle

Hands, CHG, MSB, site, remove

Hands firstCHG dryFull barrierPrompt removal

Prep Bundle

Hand hygiene
First bundle step
CHG-alcohol
Preferred antisepsis
Dry time
Must complete
MSB
Full sterile barrier
Sterile field
Protect key parts
ANTT
No-touch key parts
Trendelenburg
Reduce air entry
Consent
Risks benefits alternatives

EBP Triad

Evidence plus expertise plus preferences

Best evidenceClinician expertisePatient valuesMeasured outcomes

QI vs Research

QI

  • Improve local care
  • Process outcomes
  • Rapid cycles

Research

  • Generalizable knowledge
  • Protocol review
  • Formal methods

Local vs general

Exam Facts

Items
150 total
Scored
125 count
Pretest
25 unscored
Time
2.5 hours
Tutorial
15 minutes
Survey
15 minutes
Language
English only
Credential
3 years

Communication Ethics

Teach-back
Verify understanding
Home care
Daily protection plan
Restrictions
Protect catheter function
Caregiver
Include support person
Culture
Respect patient context
Handoff
Share device details
Refusal
Honor competent choice
Advocacy
Prevent patient harm

Common Traps

Midline is central

Midline stays peripheral ≠ PICC tip central

More lumens safer

Fewer lumens preferred ≠ More lumens raise risk

Gauge proves safety

Diameter ratio matters ≠ Gauge alone misleads

Sherlock confirms tip

Tracking guides path ≠ ECG confirms tip

Force restores patency

Resistance means assess ≠ Force can rupture

Wet CHG is acceptable

Wet prep is unsafe ≠ Dry time matters

Gauze equals TSM

Gauze hides site ≠ TSM permits assessment

CLABSI equals CRBSI

CLABSI surveillance label ≠ CRBSI clinical diagnosis

Consent after placement

Consent comes before ≠ Refusal can stand

Single culture proves DTP

Paired cultures compare ≠ Single draw weakens

Last Minute

  1. 1.150 items; 125 scored
  2. 2.Pass is scaled 90
  3. 3.Blueprint: 2025 Job Analysis
  4. 4.Patient assessment leads weight
  5. 5.Pick least invasive device
  6. 6.PICC tip: CAJ
  7. 7.Keep PICC ratio <=45%
  8. 8.Midline is peripheral
  9. 9.Vesicants need central access
  10. 10.Do not force flushing
  11. 11.TSM change 5-7 days
  12. 12.Gauze change 48 hr
  13. 13.MSB prevents CLABSI
  14. 14.Air embolism: left Trendelenburg
  15. 15.DTP needs paired cultures
  16. 16.EBP blends three inputs

VACC VA-BC Vascular Access Board Certified

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VA-BC Study Guide: The Complete Vascular Access Board Certification Study Guide with 5 Full-Length Practice Tests, Practice Questions, Real Clinical ... to Help You Pass on Your First Attempt

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