PICC Anatomy & Vascular Access Evaluation 2 — Questions and Answers
Question 1: Which vein is considered the FIRST-LINE choice for PICC insertion due to its size and straight course?
- Basilic vein (Correct answer)
- Cephalic vein
- Brachial vein
- Median cubital vein
Correct answer: Basilic vein
The basilic vein is preferred because it is the largest superficial vein of the upper arm and follows a relatively straight path toward the subclavian vein.
Question 2: The cephalic vein is less preferred for PICC placement primarily because of which anatomical feature?
- It is too small in diameter
- It makes a sharp turn at the deltopectoral groove before joining the axillary vein (Correct answer)
- It is too superficial and prone to infiltration
- It does not travel toward the superior vena cava
Correct answer: It makes a sharp turn at the deltopectoral groove before joining the axillary vein
The cephalic vein takes a sharp angulation at the cephalic arch (deltopectoral groove) before joining the axillary vein, which can impede catheter advancement.
Question 3: In which anatomical position does the tip of a properly placed PICC reside?
- Right atrium near the tricuspid valve
- Superior vena cava at the cavoatrial junction (Correct answer)
- Subclavian vein
- Innominate (brachiocephalic) vein
Correct answer: Superior vena cava at the cavoatrial junction
Optimal PICC tip position is at the cavoatrial junction or lower third of the superior vena cava, where blood flow is high enough to dilute infusates.
Question 4: When assessing a patient's arm veins using ultrasound, which characteristic confirms the vessel is a vein rather than an artery?
- Thick, hyperechoic walls that do not compress
- Thin walls that collapse easily with gentle probe pressure (Correct answer)
- Pulsatile flow on Doppler
- Smaller lumen compared to adjacent artery
Correct answer: Thin walls that collapse easily with gentle probe pressure
Veins have thin, compliant walls and collapse readily under gentle ultrasound probe compression, distinguishing them from arteries.
Question 5: The axillary vein becomes the subclavian vein at which anatomical landmark?
- The lateral border of the first rib (Correct answer)
- The medial border of the pectoralis minor muscle
- The junction with the cephalic vein
- The outer edge of the clavicle
Correct answer: The lateral border of the first rib
The axillary vein transitions into the subclavian vein at the lateral border of the first rib.
Question 6: Which patient population most commonly requires assessment of alternative veins (e.g., femoral) for central venous access because upper-extremity PICC is contraindicated?
- Patients with diabetes mellitus
- Patients with ipsilateral breast cancer treated with axillary lymph node dissection (Correct answer)
- Patients with hypertension on antihypertensives
- Patients with a BMI greater than 30
Correct answer: Patients with ipsilateral breast cancer treated with axillary lymph node dissection
Axillary lymph node dissection disrupts lymphatic drainage and increases the risk of lymphedema, making ipsilateral PICC placement contraindicated.
Question 7: During pre-insertion vascular assessment, which finding would most likely cause the PICC nurse to abandon the basilic vein and select an alternative site?
- Vein diameter of 4 mm
- Non-compressible vein with absence of flow on Doppler (Correct answer)
- Visible vein without tourniquet
- Vein depth of 1.5 cm from skin surface
Correct answer: Non-compressible vein with absence of flow on Doppler
A non-compressible vein with absent Doppler flow indicates thrombosis, making that vessel unsuitable for PICC placement.
PICC Anatomy & Vascular Access Evaluation 2
Which vein is considered the FIRST-LINE choice for PICC insertion due to its size and straight course?