Vascular Access Device Removal Flashcards

While removing a PICC, the nurse meets resistance. What is the most appropriate first action?

Answer: Stop, do not apply force, and use measures such as warm compress, repositioning, and patient relaxation before trying again

Resistance often reflects venospasm; forcing removal risks catheter fracture and embolism.

Persistent resistance to PICC removal continues despite warm compresses and a waiting period. What is the next step?

Answer: Secure the catheter with a sterile dressing and notify the provider for imaging and further evaluation

Unresolved resistance may indicate thrombus, fibrin, or knotting and requires imaging and provider involvement.

During PICC removal the catheter breaks and the proximal end disappears into the vein. Which immediate nursing action is appropriate?

Answer: Apply a tourniquet or firm pressure high on the upper arm proximal to the site, keep the patient still, and notify the provider

Restricting venous flow proximally may prevent the fragment from migrating centrally while imaging and retrieval are arranged.

Which statement about routine culture of catheter tips at removal is correct?

Answer: Tips should be cultured only when catheter-related bloodstream infection is suspected

Routine tip culture without clinical suspicion is not recommended.

When removing a catheter for suspected CRBSI and sending the tip for culture, which technique is correct?

Answer: Cleanse the skin, remove aseptically, and cut the distal 5 cm with sterile scissors into a sterile container

The distal 5 cm segment is cut aseptically for semiquantitative culture.

Which signs within minutes of CVC removal suggest venous air embolism?

Answer: Sudden dyspnea, chest pain, hypotension, and a churning 'mill-wheel' heart murmur

Air embolism causes acute cardiopulmonary compromise and may produce a mill-wheel murmur.

Air embolism is suspected immediately after CVC removal. Which position is recommended?

Answer: Left lateral decubitus with Trendelenburg

Left lateral Trendelenburg (Durant maneuver) helps trap air in the right atrium away from the pulmonary outflow tract.