PICC Anatomy & Vascular Access Evaluation 3 — Questions and Answers
Question 1: The superior vena cava (SVC) is formed by the union of which two vessels?
- Right and left subclavian veins
- Right and left brachiocephalic (innominate) veins (Correct answer)
- Right and left internal jugular veins
- Azygos vein and right brachiocephalic vein
Correct 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.
Question 2: Which nerve runs in close proximity to the basilic vein in the upper arm and can be inadvertently injured during PICC insertion?
- Radial nerve
- Ulnar nerve
- Medial cutaneous nerve of the forearm (medial antebrachial cutaneous nerve) (Correct answer)
- Musculocutaneous nerve
Correct 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.
Question 3: Using the PICC-CIRC formula for catheter length estimation, from which surface landmark is measurement typically initiated?
- Antecubital fossa
- Proposed insertion site on the upper arm (Correct answer)
- Deltoid muscle insertion point
- Medial epicondyle of the humerus
Correct 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.
Question 4: Which vessel serves as the venous drainage pathway from the upper extremity to the heart in the order: basilic → axillary → subclavian → ?
- Superior vena cava directly
- Brachiocephalic (innominate) vein, then SVC (Correct answer)
- Internal jugular, then SVC
- Azygos vein, then SVC
Correct 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.
Question 5: 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?
- Cephalic vein, because visibility reduces complication risk
- Basilic vein, because it is larger, has fewer valves, and a more direct central course (Correct answer)
- Either vessel, as both have equal outcomes
- Brachial vein, because it is closest to the basilic
Correct 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.
Question 6: The thoracic duct, which can rarely be injured during left-sided PICC procedures, drains into which venous structure?
- Left subclavian vein near its junction with the left internal jugular vein (Correct answer)
- Left brachiocephalic vein mid-segment
- Superior vena cava
- Left axillary vein
Correct 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).
Question 7: When using a tourniquet during ultrasound-guided basilic vein assessment in the upper arm, the tourniquet should be placed where?
- At the antecubital fossa to distend proximal veins
- Proximal to the proposed insertion site to distend the target vein (Correct answer)
- Distal to the proposed insertion site to impede venous return
- At the axilla to distend all arm veins
Correct 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.
PICC Anatomy & Vascular Access Evaluation 3
The superior vena cava (SVC) is formed by the union of which two vessels?