PICC Infection Prevention & Complication Management 4 — Questions and Answers
Question 1: A PICC nurse is performing a blood culture draw from a PICC in a febrile patient. Which technique is required to correctly differentiate CRBSI from other bacteremia sources?
- Draw one set from the PICC only
- Draw paired blood cultures simultaneously from the PICC and a peripheral vein (Correct answer)
- Draw blood cultures only from a peripheral site to avoid contaminating results
- Draw cultures from the PICC 30 minutes after the peripheral draw
Correct answer: Draw paired blood cultures simultaneously from the PICC and a peripheral vein
Paired simultaneous blood cultures — one through the PICC and one from a peripheral vein — are required to calculate differential time to positivity (DTP) for CRBSI diagnosis.
Question 2: What differential time to positivity (DTP) threshold, when the PICC culture turns positive earlier than the peripheral culture, is diagnostic for catheter-related bloodstream infection (CRBSI)?
- ≥1 hour
- ≥2 hours (Correct answer)
- ≥4 hours
- ≥6 hours
Correct answer: ≥2 hours
A DTP of ≥2 hours — the central line culture turning positive at least 2 hours before the peripheral culture — is the accepted diagnostic threshold for CRBSI.
Question 3: Which organism is most commonly responsible for CLABSI in patients with long-term PICCs receiving home infusion therapy?
- Pseudomonas aeruginosa
- Coagulase-negative Staphylococci (Correct answer)
- Candida albicans
- Escherichia coli
Correct answer: Coagulase-negative Staphylococci
Coagulase-negative Staphylococci, particularly S. epidermidis, are the most common organisms causing CLABSI, especially with long-term indwelling catheters, due to their strong biofilm-forming capacity.
Question 4: A patient's PICC site has a transparent semipermeable membrane (TSM) dressing that is visibly lifting at the edges and has moisture under it. The correct action is to:
- Reinforce with tape and reassess in 24 hours
- Change the dressing immediately using aseptic technique (Correct answer)
- Apply a CHG patch over the existing dressing to prevent infection
- Leave it until the scheduled weekly change
Correct answer: Change the dressing immediately using aseptic technique
A compromised dressing with lifting edges and moisture underneath must be changed immediately, as moisture under the dressing significantly increases CLABSI risk.
Question 5: Which intervention is most effective in preventing biofilm formation on PICC lumens used for prolonged therapy?
- Flushing with heparinized saline after each use only
- Using antimicrobial-impregnated or antibiotic lock solutions in high-risk patients (Correct answer)
- Irrigating with hydrogen peroxide weekly
- Capping unused lumens with regular stopcock caps
Correct answer: Using antimicrobial-impregnated or antibiotic lock solutions in high-risk patients
Antimicrobial lock solutions (e.g., ethanol, minocycline-EDTA, or taurolidine) have demonstrated efficacy in reducing biofilm-associated CLABSI in high-risk or recurrent-infection patients.
Question 6: A patient develops unilateral arm edema and facial swelling on the side of a PICC insertion. Chest X-ray shows catheter tip in the subclavian vein. Which complication is most likely?
- Catheter-associated DVT causing SVC obstruction
- Extravasation of infusate into subcutaneous tissue
- Catheter malposition with tip in the subclavian vein rather than SVC/CAJ (Correct answer)
- Pinch-off syndrome with intermittent compression
Correct answer: Catheter malposition with tip in the subclavian vein rather than SVC/CAJ
Facial and arm swelling with a catheter tip confirmed in the subclavian vein (not at the SVC/CAJ) indicates malposition, as the short non-central tip can impede venous return and cause thrombosis.
Question 7: Which action should a PICC nurse take when a patient reports a burning sensation, coolness, and swelling at the infusion site during an infusion of a vesicant agent?
- Slow the infusion rate and monitor for 30 minutes
- Stop the infusion, aspirate residual drug, and manage per vesicant extravasation protocol (Correct answer)
- Flush the line with saline to dilute the vesicant
- Apply ice and continue infusion at a reduced rate
Correct answer: Stop the infusion, aspirate residual drug, and manage per vesicant extravasation protocol
Vesicant extravasation requires immediate cessation of infusion and aspiration of residual drug followed by specific antidote administration per institutional vesicant protocol to minimize tissue damage.
PICC Infection Prevention & Complication Management 4
A PICC nurse is performing a blood culture draw from a PICC in a febrile patient.
Which technique is required to correctly differentiate CRBSI from other bacteremia sources?