PICC Infection Prevention & Complication Management 5 — Questions and Answers
Question 1: A PICC nurse is educating a patient on home PICC care. Which sign should the patient be instructed to report immediately to the healthcare provider?
- Mild bruising at the insertion site within 24 hours of placement
- Fever greater than 38°C (100.4°F) with chills and redness at the site (Correct answer)
- Mild tenderness when the arm is pressed near the insertion site
- A small amount of dried blood on the outer edge of the dressing
Correct answer: Fever greater than 38°C (100.4°F) with chills and redness at the site
Fever with chills and site redness are signs of potential CLABSI or local infection, requiring immediate medical evaluation to prevent sepsis.
Question 2: Which PICC maintenance practice has been shown to reduce the risk of catheter occlusion AND infection simultaneously?
- Using gravity flush technique with normal saline
- Scrubbing the needleless connector for ≥15 seconds with 70% alcohol before each access (Correct answer)
- Changing IV tubing every 24 hours regardless of infusate
- Aspirating blood before each infusion to verify patency
Correct answer: Scrubbing the needleless connector for ≥15 seconds with 70% alcohol before each access
Vigorous mechanical scrub of needleless connectors with 70% alcohol for ≥15 seconds (scrub-the-hub) prevents microbial contamination and reduces both CLABSI and occlusion risk.
Question 3: A patient on home TPN via PICC develops chills, fever, and rigors immediately after connecting a new bag of TPN. Which explanation is the most likely cause?
- Reaction to the lipid component of TPN
- Contaminated TPN solution or catheter hub contamination causing infusion-related bacteremia (Correct answer)
- Hypersensitivity to the dressing adhesive
- Hypothermia from refrigerated TPN infused too rapidly
Correct answer: Contaminated TPN solution or catheter hub contamination causing infusion-related bacteremia
Immediate chills and rigors upon connecting a new infusate suggest contaminated solution or hub contamination leading to infusion-related bacteremia, a CLABSI presentation.
Question 4: The PICC nurse notes that a patient's PICC was inserted 10 days ago and the current transparent dressing remains intact, dry, and adherent. What is the correct action?
- Change the dressing immediately because 7 days is the maximum interval (Correct answer)
- Leave the dressing in place since it is intact; change at the next scheduled 7-day interval
- Change the dressing within the next 24 hours regardless of appearance
- Apply a CHG disc over the existing dressing to extend the interval
Correct answer: Change the dressing immediately because 7 days is the maximum interval
Standard TSM dressings should be changed every 7 days; a dressing at day 10 is overdue for a change regardless of appearance and must be changed promptly.
Question 5: Which factor differentiates mechanical phlebitis from bacterial phlebitis in a patient with a PICC?
- Mechanical phlebitis is always accompanied by fever above 38°C
- Bacterial phlebitis typically presents within the first 24–48 hours post-insertion
- Mechanical phlebitis usually occurs in the first 24–72 hours and resolves with warm compresses, while bacterial phlebitis tends to worsen despite conservative measures (Correct answer)
- Bacterial phlebitis is always confirmed by elevated white blood cell count alone
Correct answer: Mechanical phlebitis usually occurs in the first 24–72 hours and resolves with warm compresses, while bacterial phlebitis tends to worsen despite conservative measures
Mechanical phlebitis typically appears early post-insertion and responds to conservative measures, whereas bacterial phlebitis progresses despite these interventions and requires antimicrobial treatment or line removal.
Question 6: Which PICC complication is characterized by intermittent inability to infuse when the patient's arm is in certain positions, caused by compression of the catheter between the clavicle and first rib?
- Catheter tip migration
- Pinch-off syndrome (Correct answer)
- Mechanical phlebitis
- Fibrin sheath occlusion
Correct answer: Pinch-off syndrome
Pinch-off syndrome is caused by extravascular compression of the PICC between the clavicle and first rib, producing position-dependent infusion difficulties and risk of catheter fracture.
Question 7: A patient with a PICC undergoing chemotherapy has a positive blood culture for Candida albicans. What is the recommended management for this CLABSI?
- Treat with antifungal therapy alone and retain the PICC
- Remove the PICC promptly and initiate systemic antifungal therapy (Correct answer)
- Instill antifungal lock solution and reassess in 48 hours
- Change the PICC over a guidewire and culture the old catheter tip
Correct answer: Remove the PICC promptly and initiate systemic antifungal therapy
Candida CLABSI requires prompt catheter removal along with systemic antifungal therapy, as Candida adheres strongly to biofilm and rarely clears without catheter removal.
PICC Infection Prevention & Complication Management 5
A PICC nurse is educating a patient on home PICC care.
Which sign should the patient be instructed to report immediately to the healthcare provider?