PICC Line Insertion & Maintenance 4 — Questions and Answers
Question 1: Which antiseptic agent is the PREFERRED skin preparation for PICC insertion in patients over 2 months of age?
- Povidone-iodine 10%
- >0.5% chlorhexidine gluconate in 70% isopropyl alcohol (Correct answer)
- 70% isopropyl alcohol alone
- Benzalkonium chloride
Correct answer: >0.5% chlorhexidine gluconate in 70% isopropyl alcohol
Chlorhexidine-alcohol solution provides superior residual antimicrobial activity compared to povidone-iodine and alcohol alone, per CDC and INS guidelines.
Question 2: When should a transparent semipermeable membrane (TSM) dressing on a PICC be changed?
- Every 24 hours
- Every 48 hours
- Every 5–7 days or sooner if integrity is compromised (Correct answer)
- Every 14 days
Correct answer: Every 5–7 days or sooner if integrity is compromised
TSM dressings are changed every 5–7 days per INS standards, but must be changed immediately if wet, soiled, or lifting.
Question 3: The purpose of using a vein finder or near-infrared device prior to PICC insertion is to:
- Replace ultrasound guidance
- Identify superficial vein anatomy before ultrasound assessment (Correct answer)
- Measure central venous pressure
- Confirm catheter tip placement
Correct answer: Identify superficial vein anatomy before ultrasound assessment
Near-infrared devices visualize superficial veins for preliminary assessment but do not replace ultrasound for real-time needle guidance during insertion.
Question 4: Which complication is MOST directly associated with failure to maintain a bloodless field during PICC insertion?
- Air embolism
- Catheter-related bloodstream infection (CRBSI) (Correct answer)
- Thrombophlebitis
- Pneumothorax
Correct answer: Catheter-related bloodstream infection (CRBSI)
Blood contamination at the insertion site introduces skin flora into the catheter tract, significantly increasing CRBSI risk.
Question 5: A PICC nurse is about to insert a line when the patient reports a latex allergy. The nurse should:
- Proceed using standard supplies
- Use latex-free gloves and latex-free insertion supplies (Correct answer)
- Defer to a physician for placement
- Apply a latex glove liner to prevent direct contact
Correct answer: Use latex-free gloves and latex-free insertion supplies
All supplies including gloves, tourniquet, and dressing components must be latex-free to prevent anaphylaxis in latex-allergic patients.
Question 6: Intravascular catheter-related thrombosis associated with a PICC is most commonly located in the:
- Subclavian vein
- Internal jugular vein
- Upper extremity vein (basilic, brachial, or axillary vein) (Correct answer)
- Inferior vena cava
Correct answer: Upper extremity vein (basilic, brachial, or axillary vein)
PICC-associated deep vein thrombosis most frequently affects the ipsilateral upper extremity veins through which the catheter passes.
Question 7: Which patient position is recommended during PICC removal to reduce air embolism risk?
- High Fowler's (90 degrees)
- Trendelenburg or supine with Valsalva maneuver (Correct answer)
- Prone
- Seated upright with head turned away
Correct answer: Trendelenburg or supine with Valsalva maneuver
Supine or Trendelenburg positioning with Valsalva increases intrathoracic pressure, reducing the pressure gradient that could draw air into the vein during catheter removal.
PICC Line Insertion & Maintenance 4
Which antiseptic agent is the PREFERRED skin preparation for PICC insertion in patients over 2 months of age?