PICC Line Insertion & Maintenance 3 — Questions and Answers
Question 1: Which landmark is used to estimate PICC insertion length before catheter placement?
- Nipple line to the insertion site
- Insertion site to the sternal notch to the third intercostal space (Correct answer)
- Mid-arm to the clavicle
- Antecubital fossa to the right ear lobe
Correct answer: Insertion site to the sternal notch to the third intercostal space
Measuring from the insertion site to the sternal notch and then down to the third intercostal space approximates the distance to the cavoatrial junction.
Question 2: The maximum dwell time for a PICC is determined primarily by:
- A fixed 90-day institutional policy
- Ongoing clinical need, absence of complications, and device functionality (Correct answer)
- Number of lumens in the catheter
- Patient age and weight
Correct answer: Ongoing clinical need, absence of complications, and device functionality
INS guidelines state PICCs should remain in place only as long as clinically indicated; routine replacement on a fixed schedule is not recommended.
Question 3: Trimming a PICC catheter to the correct length BEFORE insertion is important because:
- Trimming prevents catheter-related bloodstream infections
- PICCs cannot be shortened after placement without increasing infection risk (Correct answer)
- Post-insertion trimming is acceptable and commonly performed
- Catheter length does not affect tip position
Correct answer: PICCs cannot be shortened after placement without increasing infection risk
Cutting a PICC after insertion exposes the internal lumen to contaminants and compromises catheter integrity.
Question 4: Which solution is recommended for routine PICC lumen flushing in adult patients per INS standards?
- Heparinized saline 100 units/mL
- 0.9% sodium chloride (Correct answer)
- D5W
- Sterile water
Correct answer: 0.9% sodium chloride
Normal saline (0.9% NaCl) is the recommended flush solution for most PICC lumens; heparin is not routinely required.
Question 5: During PICC insertion using the modified Seldinger technique, after the guidewire is advanced, the next step is to:
- Advance the PICC directly over the needle
- Remove the needle while holding the guidewire in place (Correct answer)
- Perform a chest X-ray to confirm wire position
- Flush the guidewire with saline
Correct answer: Remove the needle while holding the guidewire in place
The needle is carefully withdrawn while maintaining guidewire position so the dilator and catheter can be threaded over the wire.
Question 6: A power-injectable PICC is distinguished from a standard PICC primarily by:
- A blue-colored catheter hub and higher pressure rating (≥300 psi) (Correct answer)
- Smaller internal diameter allowing faster flow
- Absence of clamp mechanisms
- Compatibility only with peripheral IV contrast
Correct answer: A blue-colored catheter hub and higher pressure rating (≥300 psi)
Power-injectable PICCs are rated for contrast injection at high flow rates and are identified by purple or specific color-coded hubs and 'CT Power Injectable' labeling.
Question 7: A patient's PICC was placed 5 days ago and the nurse observes 2 cm of external catheter that was not present on the previous shift's documentation. This most likely indicates:
- Normal catheter settling
- Catheter migration outward (tip retraction) (Correct answer)
- Catheter fracture
- Fluid overload
Correct answer: Catheter migration outward (tip retraction)
An increase in external catheter length means the tip has retracted proximally, potentially out of the SVC, and requires radiographic confirmation before use.
PICC Line Insertion & Maintenance 3
Which landmark is used to estimate PICC insertion length before catheter placement?