PICC Anatomy & Vascular Access Evaluation 4 — Questions and Answers
Question 1: What minimum internal diameter of the target vein is generally recommended to accommodate a PICC catheter without causing significant flow restriction?
- Greater than 2 mm
- Greater than 3 mm (Correct answer)
- Greater than 5 mm
- Greater than 7 mm
Correct answer: Greater than 3 mm
A minimum vein diameter of at least 3 mm (ideally larger) is recommended to maintain adequate blood flow around the catheter and reduce thrombosis risk.
Question 2: Which anatomical structure at the mid-upper arm can be identified by ultrasound as a hyperechoic, pulsatile structure lying medial to the basilic vein?
- Brachial artery (Correct answer)
- Ulnar artery
- Radial artery
- Anterior interosseous artery
Correct answer: Brachial artery
The brachial artery lies medial to the basilic vein in the mid-upper arm and is identifiable by its thick, pulsatile walls on ultrasound.
Question 3: A PICC nurse is assessing a patient with a history of multiple prior PICCs in the right arm. Ultrasound reveals a patent right basilic vein but echogenic material within the right brachial vein. What is the correct course of action?
- Insert PICC into the brachial vein as planned
- Use the right basilic vein only if it is patent and adequate in size (Correct answer)
- Cancel PICC placement and refer to interventional radiology
- Insert into the left arm without further assessment
Correct answer: Use the right basilic vein only if it is patent and adequate in size
Thrombosis in the brachial vein does not preclude use of the patent basilic vein; however, the patent vessel must be assessed for adequate diameter and compressibility.
Question 4: The 'Zone B' insertion site for PICC placement refers to which region of the arm?
- Forearm between the wrist and antecubital fossa
- Upper arm between the antecubital fossa and the axilla (Correct answer)
- Antecubital fossa itself
- Axilla extending to the shoulder
Correct answer: Upper arm between the antecubital fossa and the axilla
Zone B (the upper arm) is the preferred PICC insertion zone because it allows for larger vein selection and reduces complication rates compared to antecubital (Zone A) insertion.
Question 5: Which of the following conditions is an absolute contraindication to PICC placement in a specific extremity?
- Stage 1 chronic kidney disease
- End-stage renal disease with an arteriovenous fistula in that arm (Correct answer)
- Recent venipuncture in the antecubital fossa within 24 hours
- Patient preference for the non-dominant arm
Correct answer: End-stage renal disease with an arteriovenous fistula in that arm
An arteriovenous fistula or graft is an absolute contraindication for ipsilateral PICC placement because instrumentation risks fistula damage, infection, and thrombosis.
Question 6: On chest radiograph, a PICC tip seen at the level of the carina is considered to be in which location?
- Optimal position at the cavoatrial junction
- Too high — in the proximal SVC (Correct answer)
- Too low — in the right atrium
- Mispositioned in the azygos vein
Correct answer: Too high — in the proximal SVC
A tip at the carina corresponds to the proximal to mid-SVC, which is above the optimal cavoatrial junction and may require repositioning.
Question 7: Which maneuver can be used intraoperatively to redirect a PICC catheter that has malpositioned into the internal jugular vein during insertion?
- Asking the patient to take a deep breath
- Turning the patient's head toward the ipsilateral shoulder and flexing the chin down (Correct answer)
- Extending the patient's arm above the head
- Applying external pressure over the internal jugular vein
Correct answer: Turning the patient's head toward the ipsilateral shoulder and flexing the chin down
Turning the head toward the ipsilateral shoulder and flexing the chin compresses the internal jugular vein, preventing or redirecting catheter entry into it.
PICC Anatomy & Vascular Access Evaluation 4
What minimum internal diameter of the target vein is generally recommended to accommodate a PICC catheter without causing significant flow restriction?