PICC PICC Troubleshooting & Problem Resolution 2 — Questions and Answers
Question 1: A PICC line alarm indicates occlusion during a continuous infusion. After repositioning the patient, resistance persists. What is the next appropriate step?
- Remove the PICC immediately
- Aspirate with a 3 mL syringe to clear the clot
- Attempt to aspirate and assess for blood return, then consider thrombolytic therapy (Correct answer)
- Continue infusing at a lower rate
Correct answer: Attempt to aspirate and assess for blood return, then consider thrombolytic therapy
If repositioning does not resolve the occlusion, the nurse should attempt aspiration to assess patency and then follow institutional protocol for thrombolytic therapy if indicated.
Question 2: During PICC line use, a patient suddenly develops shortness of breath, hypotension, and tachycardia. The nurse suspects air embolism. What is the immediate positioning intervention?
- Semi-Fowler's position
- Trendelenburg position on the right side
- Left lateral decubitus (Durant's maneuver) with Trendelenburg (Correct answer)
- Supine with legs elevated
Correct answer: Left lateral decubitus (Durant's maneuver) with Trendelenburg
Left lateral decubitus position with Trendelenburg (Durant's maneuver) traps air in the right ventricle apex, preventing it from entering the pulmonary circulation.
Question 3: A nurse observes swelling and pain in a patient's arm above the PICC insertion site. Which complication should be suspected first?
- Catheter occlusion
- Deep vein thrombosis (DVT) (Correct answer)
- Phlebitis
- Catheter malposition
Correct answer: Deep vein thrombosis (DVT)
Arm swelling and pain above the PICC site are classic signs of deep vein thrombosis, which requires urgent diagnostic evaluation with ultrasound.
Question 4: Which finding indicates a PICC catheter has migrated into the right atrium?
- Difficulty aspirating blood return
- Cardiac arrhythmias noted on telemetry (Correct answer)
- Increased resistance during flushing
- Erythema at the insertion site
Correct answer: Cardiac arrhythmias noted on telemetry
Cardiac arrhythmias, particularly atrial dysrhythmias, can indicate that the PICC tip has migrated into the right atrium and requires immediate repositioning.
Question 5: A patient with a PICC line develops a fever, chills, and hypotension without an obvious infection source. What should the nurse suspect?
- Phlebitis at the insertion site
- Catheter-related bloodstream infection (CRBSI) (Correct answer)
- Infiltration of IV fluids
- Air embolism
Correct answer: Catheter-related bloodstream infection (CRBSI)
Systemic signs of infection (fever, chills, hypotension) without another source in a patient with a PICC are classic indicators of a catheter-related bloodstream infection.
Question 6: When troubleshooting a sluggish PICC infusion, the nurse elevates the patient's arm and the flow improves. This suggests what cause?
- Fibrin sheath occlusion
- Positional occlusion due to catheter tip location (Correct answer)
- Complete thrombotic occlusion
- Catheter fracture
Correct answer: Positional occlusion due to catheter tip location
Flow improvement with arm elevation indicates a positional occlusion, where the catheter tip may be partially obstructed by the vessel wall depending on arm position.
PICC PICC Troubleshooting & Problem Resolution 2
A PICC line alarm indicates occlusion during a continuous infusion.
After repositioning the patient, resistance persists.
What is the next appropriate step?