AIIMS BHOPAL NO- 2018( Shift-2nd)
Applied Microbiology & Infection control
Medium
Which of the following is NOT a precaution to be taken in case of a patient with a central IV line?
Appeared in: AIIMS BHOPAL NO- 2018( Shift-2nd)
Explanation
- Routine, scheduled replacement of central venous catheters (CVCs) is not a recommended practice for preventing infection.
- CVCs are intended for medium to long-term access and should only be removed or replaced when there is a specific clinical indication, such as a confirmed infection, thrombosis, malfunction, or when the line is no longer needed.
- Frequent, unnecessary replacement increases the risk of mechanical complications like bleeding, pneumothorax, and arterial puncture, while also exposing the patient to new infection risks associated with insertion.
Why Other Options Were Wrong
- Option A: Hand hygiene is the single most important and fundamental measure to prevent the transmission of pathogens and reduce the risk of CLABSI.
- Option B: Skin antisepsis, preferably with a chlorhexidine-based solution, is a critical evidence-based practice included in the CLABSI prevention bundle to disinfect the insertion site.
- Option C: Optimal site selection is a key component of CLABSI prevention. In adults, avoiding the femoral vein and preferring the subclavian vein is recommended to minimize infection risk.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Infection control measures for central venous catheters (CVC) and prevention of Central Line-Associated Bloodstream Infections (CLABSI) to guide bedside assessment, documentation, and the next nursing action.
- Nurses are at the forefront of preventing CLABSI by meticulously adhering to the central line care bundle during insertion, maintenance, and access.
- Failure to follow these precautions can lead to serious, life-threatening bloodstream infections, which significantly increase patient morbidity, mortality, and healthcare costs.
- What if? - If a patient with a CVC develops a fever without an obvious source, the nurse's priority is to notify the provider and prepare for blood cultures to be drawn from both the CVC and a peripheral site to investigate for CLABSI, rather than assuming the line needs to be changed.
How to Approach the Question
- First, identify the core concept of the question, which is infection prevention for a central IV line.
- Note the negative keyword 'NOT'. This means you are looking for the option that is an incorrect or contraindicated action.
- Recall the standard evidence-based practices for central line care, often grouped as a 'CLABSI bundle'.
- Evaluate each option: Is hand hygiene a precaution? Yes. Is skin antisepsis a precaution? Yes. Is site selection important? Yes.
- Consider the final option: 'Changing the line everyday'. This is an invasive, high-risk procedure. Standard practice is to leave lines in place as long as they are needed and functioning properly, not to replace them routinely. This makes it the correct answer for a 'NOT' question.
Concept Tested & Keywords
- Concept Tested: Infection control measures for central venous catheters (CVC) and prevention of Central Line-Associated Bloodstream Infections (CLABSI).
- Stem keywords: central IV line, precaution
- Lead-in keywords: NOT
- Negative lead-in flag: The question asks to identify the action that is NOT a standard precaution, requiring the test-taker to differentiate between recommended and non-recommended practices for central line care.
Question ID
Q_-wiggVAeB-4MdZElF8Pt
Reference Book
E6 Medicine Harrison 22e Part 1 p. 1189-1191
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 69-71
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1672-1674
Practise the full AIIMS BHOPAL NO- 2018( Shift-2nd)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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