PICC Infection Prevention & Complication Management 3 — Questions and Answers
Question 1: A PICC nurse is selecting insertion site for a patient requiring long-term IV access. Which vein is preferred to minimize infection risk while maintaining patient comfort?
- Basilic vein (Correct answer)
- Cephalic vein
- Brachial vein
- Median cubital vein
Correct answer: Basilic vein
The basilic vein is the preferred site for PICC insertion as it is the largest antecubital vein, has the straightest path to central circulation, and is associated with fewer complications.
Question 2: Which type of PICC dressing change schedule is recommended for a CHG-impregnated sponge dressing?
- Every 24 hours
- Every 48 hours
- Every 7 days or when soiled/loose (Correct answer)
- Every 14 days
Correct answer: Every 7 days or when soiled/loose
CHG-impregnated sponge dressings should be changed every 7 days or sooner if the dressing becomes soiled, loosened, or compromised.
Question 3: A patient with a PICC suddenly develops dyspnea, chest pain, and a drop in oxygen saturation during an infusion. The most immediate concern should be which complication?
- Catheter-associated thrombosis
- Air embolism (Correct answer)
- Pinch-off syndrome
- Catheter tip migration
Correct answer: Air embolism
Sudden dyspnea, chest pain, and desaturation during IV infusion are classic signs of air embolism, a life-threatening emergency requiring immediate intervention.
Question 4: When an air embolism is suspected in a patient with a PICC, which positioning intervention is immediately indicated?
- Semi-Fowler's position with head elevated 45 degrees
- Supine with legs elevated (Trendelenburg)
- Left lateral decubitus (Durant's maneuver) with Trendelenburg (Correct answer)
- Right lateral decubitus with head of bed elevated
Correct answer: Left lateral decubitus (Durant's maneuver) with Trendelenburg
Durant's maneuver — left lateral decubitus with Trendelenburg positioning — traps air in the right ventricle apex, preventing pulmonary artery obstruction.
Question 5: Which bundle element is NOT part of the standardized CLABSI prevention bundle for PICC lines?
- Maximal barrier precautions during insertion
- Chlorhexidine skin antisepsis
- Daily reassessment of line necessity
- Routine prophylactic antibiotic administration prior to insertion (Correct answer)
Correct answer: Routine prophylactic antibiotic administration prior to insertion
Routine prophylactic antibiotics before PICC insertion are not recommended and are not part of the CLABSI bundle; such practice promotes antimicrobial resistance.
Question 6: A patient receiving chemotherapy via PICC reports sudden pain and swelling in the ipsilateral arm. Doppler ultrasound confirms deep vein thrombosis. Which is the standard initial management for PICC-associated DVT in non-high-bleeding-risk patients?
- Immediate PICC removal and warm compresses only
- Anticoagulation therapy with the PICC retained if functional and still needed (Correct answer)
- Surgical thrombectomy
- Thrombolytic infusion through the PICC
Correct answer: Anticoagulation therapy with the PICC retained if functional and still needed
Current guidelines recommend anticoagulation while retaining the PICC if it remains functional and is still clinically required, removing it only if no longer needed or nonfunctional.
Question 7: Which patient factor most significantly increases the risk of PICC-associated CLABSI in critically ill patients?
- Age over 50 years
- Total parenteral nutrition administration (Correct answer)
- Female sex
- PICC inserted in the basilic vein
Correct answer: Total parenteral nutrition administration
Total parenteral nutrition is a major independent risk factor for CLABSI because its high glucose and lipid content creates an ideal medium for microbial growth within the catheter.
PICC Infection Prevention & Complication Management 3
A PICC nurse is selecting insertion site for a patient requiring long-term IV access.
Which vein is preferred to minimize infection risk while maintaining patient comfort?