VABC Insertion Techniques & Complications Management 2 — Questions and Answers
Question 1: During ultrasound-guided PICC insertion, the needle tip is visualized in the short-axis view. What is the primary limitation of this approach compared to long-axis?
- It requires a larger probe footprint
- The shaft of the needle may be out of plane and difficult to track (Correct answer)
- It cannot visualize veins smaller than 5 mm
- It increases the risk of air embolism
Correct answer: The shaft of the needle may be out of plane and difficult to track
Short-axis view shows the needle tip as a dot but cannot continuously track the shaft, risking inadvertent posterior wall puncture.
Question 2: A patient develops a hematoma at the PICC insertion site immediately after insertion. Which action is the MOST appropriate initial response?
- Remove the PICC and apply a pressure dressing
- Apply firm manual pressure for at least 5 minutes (Correct answer)
- Notify the physician and prepare for surgical intervention
- Flush the PICC with heparin to prevent clotting
Correct answer: Apply firm manual pressure for at least 5 minutes
Firm manual pressure applied directly over the hematoma for at least 5 minutes is the first-line intervention to stop bleeding.
Question 3: When using the Seldinger technique for CVC insertion, the guidewire is inserted and the patient suddenly develops PVCs on the cardiac monitor. What is the most likely cause?
- Arterial puncture has occurred
- The guidewire has advanced into the right ventricle (Correct answer)
- The patient is having a vasovagal reaction
- Air has entered the venous system
Correct answer: The guidewire has advanced into the right ventricle
A guidewire advanced too far into the heart can irritate the right ventricular wall, triggering premature ventricular contractions.
Question 4: Which of the following is the correct sequence for the modified Seldinger technique used in PICC insertion?
- Venipuncture → guidewire → dilator → catheter → stylet removal
- Venipuncture → catheter → guidewire → dilator → position confirmation
- Venipuncture → guidewire → peel-away introducer → catheter → introducer removal (Correct answer)
- Venipuncture → dilator → guidewire → catheter → position confirmation
Correct answer: Venipuncture → guidewire → peel-away introducer → catheter → introducer removal
The modified Seldinger technique involves venipuncture, guidewire insertion, placement of a peel-away introducer over the wire, threading the catheter, then splitting away the introducer.
Question 5: A nurse inserts a midline catheter and notes blood return is dark red and non-pulsatile. Despite this, the patient's arm becomes swollen and painful within minutes. What has most likely occurred?
- Venous thrombosis
- Inadvertent arterial placement with venous-appearing blood due to hypoxia
- Catheter malposition in a collateral vessel
- Lymphatic vessel cannulation (Correct answer)
Correct answer: Lymphatic vessel cannulation
Lymphatic vessels can produce non-pulsatile, clear to slightly yellow fluid, but cannulation of lymphatics can cause lymphedema and swelling; however, in the antecubital region, a soft tissue hematoma from nearby arterial trauma is also possible — lymphatic cannulation is the classic distractor answer here, but the correct answer is lymphatic vessel cannulation causing lymphedema.
Question 6: A patient receiving a vesicant chemotherapy infusion through a peripheral IV begins to complain of burning and the nurse notes swelling around the site. This is BEST classified as:
- Phlebitis grade 2
- Infiltration
- Extravasation (Correct answer)
- Thrombophlebitis
Correct answer: Extravasation
Extravasation is the inadvertent leakage of a vesicant or irritant medication into surrounding tissue, causing potential tissue necrosis.
Question 7: Which vein is considered the PREFERRED target for ultrasound-guided PICC insertion in adult patients?
- Cephalic vein
- Basilic vein (Correct answer)
- Brachial vein
- Median antebrachial vein
Correct answer: Basilic vein
The basilic vein is preferred for PICC insertion because it is the largest, most medially located upper arm vein with a straighter path to the subclavian and superior vena cava.
VABC Insertion Techniques & Complications Management 2
During ultrasound-guided PICC insertion, the needle tip is visualized in the short-axis view.
What is the primary limitation of this approach compared to long-axis?