Anatomy & Vascular Access Evaluation Flashcards

The superior vena cava (SVC) is formed by the union of which two vessels?

Answer: Right and left brachiocephalic (innominate) veins

The SVC is formed by the union of the right and left brachiocephalic (innominate) veins behind the right first costal cartilage.

Which nerve runs in close proximity to the basilic vein in the upper arm and can be inadvertently injured during PICC insertion?

Answer: Medial cutaneous nerve of the forearm (medial antebrachial cutaneous nerve)

The medial cutaneous nerve of the forearm (MACN) runs adjacent to the basilic vein in the upper arm and is at risk of injury during insertion.

Using the PICC-CIRC formula for catheter length estimation, from which surface landmark is measurement typically initiated?

Answer: Proposed insertion site on the upper arm

Measurement begins at the proposed insertion site, then extends to the right sternal border at the third intercostal space to estimate required catheter length.

Which vessel serves as the venous drainage pathway from the upper extremity to the heart in the order: basilic → axillary → subclavian → ?

Answer: Brachiocephalic (innominate) vein, then SVC

After the subclavian vein, blood flows into the brachiocephalic vein, which then joins the contralateral brachiocephalic vein to form the SVC.

A PICC nurse notes that a patient has a large, easily visible cephalic vein but a deep, non-visible basilic vein. Using best practice, which vessel should be selected and why?

Answer: Basilic vein, because it is larger, has fewer valves, and a more direct central course

Despite being deeper and requiring ultrasound guidance, the basilic vein is preferred because of its larger caliber, fewer venous valves, and more direct path to the SVC.

The thoracic duct, which can rarely be injured during left-sided PICC procedures, drains into which venous structure?

Answer: Left subclavian vein near its junction with the left internal jugular vein

The thoracic duct drains into the venous system at the junction of the left subclavian vein and the left internal jugular vein (left venous angle).

When using a tourniquet during ultrasound-guided basilic vein assessment in the upper arm, the tourniquet should be placed where?

Answer: Proximal to the proposed insertion site to distend the target vein

Placing the tourniquet proximal to the insertion site impedes venous return from that site distally, causing the target vein to distend and become easier to cannulate.