PICC Anatomy & Vascular Access Evaluation 5

Question 1

The azygos vein, into which a PICC can malposition, enters the SVC at approximately which vertebral level?

Accepted Answer

T4

Answer

The azygos vein arches over the right main bronchus and drains into the posterior aspect of the SVC at approximately the T4 vertebral level.

Question 2

A patient with a BMI of 42 requires PICC placement. The bedside nurse cannot visualize or palpate any arm veins. Which technology is the standard of care for vascular access in this situation?

Accepted Answer

Real-time ultrasound guidance

Answer

Real-time ultrasound guidance is the standard of care for PICC insertion, especially in patients where veins are not visible or palpable.

Question 3

During vein assessment, the PICC nurse identifies that the patient's basilic vein has a valve 2 cm proximal to the intended insertion site. What is the best course of action?

Accepted Answer

Insert distal to the valve and use gentle, steady advancement to pass through it

Answer

Venous valves can usually be navigated by inserting distal to the valve and using gentle, consistent advancement; saline flushing or slight catheter rotation may also assist passage.

Question 4

Which of the following veins is a paired deep vein that accompanies the brachial artery and should be avoided for PICC insertion due to increased risk of arterial injury?

Accepted Answer

Brachial veins (venae comitantes)

Answer

The brachial veins (venae comitantes) travel in close proximity to the brachial artery and are deep veins that carry higher risk of arterial puncture; they should not be the primary PICC target.

Question 5

The right brachiocephalic vein is shorter and more vertical than the left. Which clinical implication does this have for PICC insertion?

Accepted Answer

Right-sided PICC insertion typically requires a shorter catheter length than left-sided insertion

Answer

Because the right brachiocephalic vein is shorter and takes a more direct route to the SVC, right-sided PICCs generally require shorter catheter lengths than left-sided insertions.

(PICC) Peripherally Inserted Central Catheter Certified Nurse Practice Test

(PICC) Peripherally Inserted Central Catheter Certified Nurse Practice Test

PICC Anatomy & Vascular Access Evaluation 5