PICC Infection Prevention & Complication Management 2 — Questions and Answers
Question 1: A patient with a PICC develops erythema, warmth, and tenderness along the catheter tract extending 2 cm from the insertion site. Which complication does this presentation most likely indicate?
- Deep vein thrombosis
- Phlebitis (Correct answer)
- Catheter-related bloodstream infection
- Extravasation
Correct answer: Phlebitis
Erythema, warmth, and tenderness along the catheter tract are classic signs of phlebitis, which can be mechanical, chemical, or infectious in origin.
Question 2: When using the VIP (Visual Infusion Phlebitis) scale to assess a PICC site, a score of 2 indicates which finding?
- No signs of phlebitis — observe the cannula
- One of the following: pain, erythema, or swelling (Correct answer)
- Two of the following: pain, erythema, swelling, or streak
- Advanced stage thrombophlebitis — resite immediately
Correct answer: One of the following: pain, erythema, or swelling
A VIP score of 2 indicates one early sign of phlebitis (pain, erythema, or swelling) and warrants increased monitoring.
Question 3: A PICC nurse is preparing to change a dressing over a newly inserted PICC. Which agent is the preferred antiseptic for skin antisepsis per INS standards?
- Povidone-iodine 10%
- Isopropyl alcohol 70% alone
- Chlorhexidine gluconate ≥0.5% in alcohol (Correct answer)
- Normal saline with betadine rinse
Correct answer: Chlorhexidine gluconate ≥0.5% in alcohol
Chlorhexidine gluconate ≥0.5% in alcohol is the preferred antiseptic for central line dressing changes per INS and CDC guidelines due to its superior residual activity.
Question 4: Which finding during routine PICC assessment requires immediate line removal and culture of the catheter tip?
- Mild tenderness at the insertion site with no fever
- Purulent drainage at the insertion site with fever and hemodynamic instability (Correct answer)
- Serosanguineous drainage on the dressing within 24 hours of insertion
- VIP score of 1 with mild erythema only
Correct answer: Purulent drainage at the insertion site with fever and hemodynamic instability
Purulent drainage with systemic signs of sepsis (fever, hemodynamic instability) is a definitive indication for PICC removal and catheter tip culture.
Question 5: A patient's PICC lumen is occluded and does not flush. Which intervention is most appropriate as the FIRST step?
- Forcefully irrigate with 10 mL normal saline using a 1 mL syringe
- Attempt to aspirate, then reposition the patient and assess catheter tip position (Correct answer)
- Immediately remove the PICC and insert a new one
- Instill tPA (alteplase) without further assessment
Correct answer: Attempt to aspirate, then reposition the patient and assess catheter tip position
The first step for occlusion is to assess for position-related causes by repositioning the patient and checking for kinked tubing before instilling thrombolytics.
Question 6: Ethanol lock therapy is used in PICC management primarily to address which complication?
- Mechanical phlebitis
- Recurrent catheter-associated bloodstream infections in high-risk patients (Correct answer)
- Air embolism prevention
- Post-insertion hematoma
Correct answer: Recurrent catheter-associated bloodstream infections in high-risk patients
Ethanol lock therapy is an antimicrobial strategy used to prevent recurrent CRBSIs in high-risk patients, particularly those requiring long-term PICC access.
Question 7: A PICC-dependent patient receiving TPN is noted to have glucose in the catheter lumen during a blood draw. Which complication should the nurse suspect?
- Fibrin sheath formation
- Catheter malposition
- Pinch-off syndrome
- Drug precipitation occlusion (Correct answer)
Correct answer: Drug precipitation occlusion
Glucose appearing in aspirated blood from a catheter lumen used for TPN suggests drug/nutrient precipitation causing partial occlusion within the lumen.
PICC Infection Prevention & Complication Management 2
A patient with a PICC develops erythema, warmth, and tenderness along the catheter tract extending 2 cm from the insertion site.
Which complication does this presentation most likely indicate?