PICC PICC Equipment & Device Selection 3

Question 1

What is the gold standard method for confirming PICC tip placement after insertion?

Accepted Answer

Post-insertion chest X-ray

Answer

Fluoroscopy performed during the insertion

Answer

EKG-guided real-time tip confirmation

Answer

Bedside ultrasound of the superior vena cava

Question 2

The optimal PICC tip position in an adult patient is at:

Accepted Answer

The cavoatrial junction (CAJ) or lower third of the SVC

Answer

The subclavian vein

Answer

The axillary vein

Answer

The mid-right atrium

Question 3

During EKG-guided PICC tip confirmation, which waveform change indicates the tip has reached the cavoatrial junction?

Accepted Answer

The P-wave increases in amplitude, then becomes biphasic as the tip enters the right atrium, signaling slight withdrawal is needed

Answer

Gradual loss of the QRS complex

Answer

T-wave inversion at the CAJ

Answer

Widening of the QRS complex indicating atrial contact

Question 4

Which external measurement is used to estimate insertion length before placing a PICC?

Accepted Answer

Measured length from the intended insertion site, along the arm, across the shoulder to approximately the sternal notch or third intercostal space

Answer

Patient height and weight combined

Answer

Arm circumference at the mid-upper arm

Answer

Distance from the antecubital fossa to the shoulder

Question 5

Before using a PICC with a power injector for a contrast CT scan, the nurse must verify which of the following?

Accepted Answer

The catheter or hub is labeled 'CT Injectable' or 'Power Injectable' by the manufacturer

Answer

The PICC was inserted less than 48 hours ago

Answer

The patient's arm is positioned above heart level during injection

Answer

The catheter is a single-lumen device only

Question 6

A patient requires simultaneous administration of TPN with lipids and an IV antibiotic known to be incompatible with lipid emulsions. Which PICC is MOST appropriate?

Accepted Answer

Dual-lumen 5 Fr PICC

Answer

Single-lumen 4 Fr PICC

Answer

Midline catheter

Answer

Peripherally inserted non-tunneled CVC

Question 7

Which consideration is MOST important when selecting a PICC insertion vein in the upper arm using ultrasound?

Accepted Answer

Choosing a vein with a diameter at least three times the catheter French size to maintain a catheter-to-vein ratio ≤33%

Answer

Selecting the most superficial vein available regardless of diameter

Answer

Always selecting the cephalic vein as first choice due to its direct path to the SVC

Answer

Selecting the vein with the highest visible blood flow on Doppler regardless of size