Free VA-BC Exam Flashcards

The basilic vein is often preferred for PICCs because it is usually larger and straighter than the cephalic vein. The consequence is better catheter advancement and lower malposition risk when anatomy is suitable.

The cephalic vein can narrow and angle sharply near the shoulder. That bend makes catheter advancement harder and increases the chance that a PICC will not reach the desired central tip location.

The catheter should occupy no more than 45% of the vessel diameter for a PICC. A larger ratio leaves less blood flow around the catheter and increases thrombosis risk.

Coagulation status helps predict bleeding and hematoma risk during vascular access procedures. Abnormal results may require provider review, device adjustment, or a different insertion plan.

Allergy review prevents avoidable reactions to gloves, dressings, securement, or skin prep. A documented allergy should drive product substitution before the tray is opened.

A common route is basilic or brachial to axillary, then subclavian, brachiocephalic, and superior vena cava. Knowing this path helps identify where resistance, looping, or malposition may occur.

History such as mastectomy with lymph node removal, dialysis access, thrombosis, or severe edema can make an arm a poor choice. Choosing another site protects circulation and future access options.

Diagnosis, therapy duration, vessel history, renal status, mobility, and home-care needs all affect device selection. The best device is the least invasive one that safely supports the ordered therapy.

Ultrasound confirms vein depth, diameter, compressibility, and nearby arteries or nerves. Compressibility helps distinguish a patent vein from thrombosed or nonusable anatomy.

MAGIC is an appropriateness guide for choosing peripheral IVs, midlines, PICCs, and other devices based on duration, infusate, setting, and patient risk. It supports selection decisions rather than tip confirmation or dressing care.

A short peripheral catheter is best for short, peripheral-compatible therapy when veins are adequate. It is not the right choice for prolonged therapy, vesicants, or infusates requiring central dilution.

A midline can support many peripheral-compatible therapies for intermediate duration, commonly about 1-4 weeks. It is not a central line, so vesicants and therapies requiring central tip placement remain inappropriate.

A PICC is appropriate when therapy requires central venous access, longer duration, reliable blood sampling, or infusates needing high blood flow. The tradeoff is higher central-vein thrombosis and preservation concerns than peripheral devices.

A non-tunneled central venous catheter is used for acute central access, often in critical care or urgent therapy. It is not the preferred long-term outpatient device because infection and dislodgement risks are higher.

A tunneled external catheter provides frequent long-term access without repeated needle puncture. An implanted port sits fully under the skin and is often preferred when intermittent long-term access and lower daily maintenance are priorities.

A PICC can cause central vein stenosis or thrombosis that jeopardizes future dialysis access. In patients with advanced kidney disease, preserve upper-extremity veins and consult the care team before placing a PICC.

A tunneled cuffed hemodialysis catheter is used when longer-term dialysis access is needed and an AV fistula or graft is not ready or possible. The cuff anchors the catheter and lowers infection risk compared with non-tunneled access.

The sequence is needle access, guidewire, dilator or introducer, then catheter advancement. The guidewire maintains vessel access while the tract is prepared for the final catheter.

The desired PICC tip location is near the cavoatrial junction, at the lower SVC near the right atrium. This position provides high blood flow for dilution and lowers malfunction or thrombosis risk.

As the catheter approaches the cavoatrial junction, P-wave amplitude rises and is used to guide final tip position. It is a physiologic confirmation method, not a substitute when ECG criteria are unavailable or unreliable.

Sherlock TLS uses magnetic tracking to show catheter tip direction during advancement and may pair with ECG confirmation. Tracking helps navigation; final acceptability still depends on proper tip confirmation criteria.

Insertion documentation establishes what was placed, where, under what conditions, how tip position was confirmed, and whether complications occurred. Missing details weaken continuity of care and legal defensibility.

CHG-alcohol antisepsis relies on friction and complete drying before puncture or dressing. Inserting through wet antiseptic can reduce effectiveness and may irritate tissue or compromise dressing adhesion.

For central venous catheter insertion, maximal sterile barriers include cap, mask, sterile gown, sterile gloves, and a large sterile drape. The goal is to reduce organism transfer at insertion and lower CLABSI risk.

Core bundle elements include hand hygiene, appropriate skin antisepsis, maximal sterile barriers, optimal site selection, and prompt removal when no longer needed. Bundle reliability matters more than any single checklist item alone.

For central line removal, flat or Trendelenburg positioning with breath hold or Valsalva when appropriate increases venous pressure. This lowers the pressure gradient that can pull air into the venous system.

Consent requires the patient or representative to understand the procedure, benefits, risks, and alternatives. The consequence is ethical and legal: a technically successful insertion can still be improper if consent was invalid.

A transparent dressing is commonly changed every 5-7 days and sooner if damp, loose, visibly soiled, or site assessment requires it. Waiting longer can trap moisture or contamination at the site.

Gauze dressings require more frequent changes than transparent dressings, commonly every 48 hours or sooner if compromised. Gauze hides the insertion site, so assessment and moisture control drive the shorter interval.

Needleless connectors must be disinfected before access with adequate friction and contact time. Skipping hub disinfection can directly inoculate organisms into the catheter lumen.

Pulsatile flushing uses start-stop turbulence to help clear the catheter lumen. It is different from forceful flushing; resistance should prompt assessment rather than higher pressure.

Positive-pressure technique maintains outward flow as the syringe is disconnected or the clamp is engaged. The goal is to reduce reflux that can contribute to intraluminal clot formation.

A sutureless securement device anchors the catheter without sutures through the skin. It reduces catheter motion and avoids suture-related tissue injury or microbial entry points.

Needleless connectors are changed with administration set changes and when integrity, blood residue, or contamination is a concern. Unnecessary frequent changes increase line manipulation and infection opportunity.

Mechanical occlusion comes from kinking, clamps, tight sutures, malposition, or patient position. The fix is assessment and correction of the mechanical cause, not alteplase as the first move.

Thrombotic occlusion is caused by clot in or around the catheter and may require a fibrinolytic such as alteplase by protocol. It must be distinguished from mechanical or precipitate occlusions to avoid ineffective treatment.

A fibrin tail may allow flushing but block blood withdrawal when aspiration pulls it over the catheter opening. The clue is easy infusion with absent or sluggish blood return.

Lipid deposits can occur with lipid-containing infusions such as parenteral nutrition. They require a precipitate-specific approach, not a thrombolytic intended for blood clots.

Grade 3 phlebitis includes pain, erythema, streak formation, and a palpable venous cord. It signals clinically significant vein inflammation and requires catheter removal and documentation per policy.

Extravasation is leakage of a vesicant into surrounding tissue. It is more dangerous than simple infiltration because tissue injury, blistering, or necrosis can occur without prompt intervention.

Sudden dyspnea, chest pain, hypotension, neurologic changes, or a mill-wheel murmur during line manipulation can indicate venous air embolism. Immediate positioning, oxygen, and emergency response are priorities.

Pinch-off syndrome occurs when a catheter is compressed between the clavicle and first rib, classically with subclavian routes. Positional occlusion can progress to catheter fracture and embolization.

Evidence-based practice combines best research evidence, clinician expertise, and patient preferences. For VA-BC, it means applying standards while still individualizing access decisions to the patient.

Quality improvement tests process changes to improve local care outcomes, while research is designed to create generalizable knowledge. The distinction affects review requirements, consent, and how results are used.

Root cause analysis looks for system contributors such as supply gaps, training drift, documentation failures, or missed maintenance steps. The goal is prevention, not individual blame.

Scope is defined by licensure, state rules, facility policy, competency, and provider orders. Certification supports expertise but does not automatically authorize procedures outside the clinician's legal or institutional scope.

A competent patient may refuse vascular access even when clinicians believe the device is beneficial. The clinician should explain risks, notify the provider, and document the refusal and education provided.

Documentation should be complete, objective, timely, and limited to relevant clinical facts. Poor documentation can obscure catheter history, delay complication recognition, and weaken legal defense.

For pump rates, divide volume by time: mL per hour = total mL / hours. A wrong rate can underdose therapy, overload the patient, or worsen medication toxicity.

For gravity tubing, gtt/min = volume in mL x drop factor / time in minutes. Always match the drop factor to the tubing package because microdrip and macrodrip sets differ.