PICC Line Insertion & Maintenance 2 — Questions and Answers
Question 1: Which vein is considered the FIRST-CHOICE insertion site for PICC placement in adult patients?
- Cephalic vein
- Basilic vein (Correct answer)
- Median cubital vein
- Brachial vein
Correct answer: Basilic vein
The basilic vein is preferred because it is larger, straighter, and has fewer valves than the cephalic vein, facilitating easier catheter advancement.
Question 2: When using ultrasound guidance for PICC insertion, the needle entry angle should typically be:
- 10–15 degrees
- 30–45 degrees (Correct answer)
- 60–75 degrees
- 90 degrees
Correct answer: 30–45 degrees
A 30–45 degree angle optimizes needle visualization under ultrasound while achieving adequate vein penetration depth.
Question 3: After successful PICC placement, the ideal catheter tip position is:
- Mid-subclavian vein
- Superior vena cava–right atrial junction (Correct answer)
- Right ventricle
- Innominate vein
Correct answer: Superior vena cava–right atrial junction
Placement at the cavoatrial junction (lower third of the SVC) allows high blood flow to dilute infusates and reduces thrombosis risk.
Question 4: A PICC dressing should be changed every 7 days when using a chlorhexidine-impregnated sponge dressing AND whenever the dressing is:
- More than 48 hours old
- Damp, loosened, or visibly soiled (Correct answer)
- Changed by a different nurse
- Covered by a second dressing
Correct answer: Damp, loosened, or visibly soiled
INS standards require immediate dressing change if integrity is compromised, regardless of scheduled interval.
Question 5: Which flushing technique is recommended to prevent PICC occlusion?
- Rapid bolus push
- Pulsatile (push-pause) flush followed by positive-pressure cap closure (Correct answer)
- Continuous gravity drip
- Slow steady infusion of saline
Correct answer: Pulsatile (push-pause) flush followed by positive-pressure cap closure
The pulsatile technique creates turbulence that removes fibrin and drug residue from catheter walls better than a steady flush.
Question 6: When measuring external PICC catheter length for documentation, the nurse measures from the:
- Insertion site to the hub
- Hub to the end of the extension set
- Skin exit site to the catheter hub (Correct answer)
- Needle entry point to the clavicle
Correct answer: Skin exit site to the catheter hub
External length is measured from the skin exit site to the hub to track migration of the catheter tip over time.
Question 7: A nurse notes resistance when flushing a PICC line. The FIRST action should be:
- Apply forceful pressure to clear the obstruction
- Assess for kinking, clamp position, or patient arm position (Correct answer)
- Remove the catheter immediately
- Instill 2 mg tPA without further assessment
Correct answer: Assess for kinking, clamp position, or patient arm position
Mechanical causes such as kinking, a closed clamp, or a kinked extension set must be ruled out before assuming a clot occlusion.
PICC Line Insertion & Maintenance 2
Which vein is considered the FIRST-CHOICE insertion site for PICC placement in adult patients?