PICC PICC Troubleshooting & Problem Resolution 1 — Questions and Answers
Question 1: A nurse attempts to flush a PICC line and encounters resistance. What is the FIRST action the nurse should take?
- Forcefully flush with a 10 mL syringe
- Assess for catheter kinking or positional changes (Correct answer)
- Immediately remove the PICC line
- Instill a thrombolytic agent
Correct answer: Assess for catheter kinking or positional changes
Before any intervention, the nurse should assess for mechanical causes such as catheter kinking, patient position, or external clamping that may be causing the resistance.
Question 2: Which syringe size is recommended when flushing a PICC line to avoid generating excessive pressure that could damage the catheter?
- 1 mL syringe
- 3 mL syringe
- 10 mL syringe (Correct answer)
- 60 mL syringe
Correct answer: 10 mL syringe
A 10 mL syringe generates lower pressure per psi than smaller syringes and is the minimum recommended size for flushing PICCs to prevent catheter damage.
Question 3: A patient's PICC line is infusing but blood cannot be aspirated. What is the most likely cause?
- Complete catheter occlusion
- Fibrin tail or fibrin sheath formation (Correct answer)
- Air embolism
- Catheter fracture
Correct answer: Fibrin tail or fibrin sheath formation
A fibrin tail or sheath acts as a one-way valve, allowing infusion but preventing blood aspiration from the catheter.
Question 4: Alteplase (tPA) is ordered to restore patency in an occluded PICC. What is the standard dwell time before attempting aspiration?
- 5–10 minutes
- 30–60 minutes (Correct answer)
- 2–4 hours
- Overnight (8–12 hours)
Correct answer: 30–60 minutes
The standard protocol for alteplase instillation in a PICC is a 30–60 minute dwell time before attempting to aspirate and restore patency.
Question 5: A nurse notices that the external length of a patient's PICC has increased by 3 cm since insertion. What does this indicate?
- Normal catheter migration during activity
- The PICC has migrated outward and tip position must be verified (Correct answer)
- The catheter needs immediate removal
- Air embolism has occurred
Correct answer: The PICC has migrated outward and tip position must be verified
An increase in external catheter length indicates outward migration, which may mean the tip is no longer in the superior vena cava and requires radiographic confirmation.
Question 6: Which intervention is appropriate when a PICC line leaks at the insertion site during infusion?
- Apply a pressure dressing and continue infusion
- Stop infusion and assess for catheter damage or dislodgement (Correct answer)
- Increase infusion rate to overcome leakage
- Aspirate through the line and restart infusion
Correct answer: Stop infusion and assess for catheter damage or dislodgement
Leaking at the insertion site requires stopping the infusion immediately and assessing whether the catheter is damaged, dislodged, or the dressing needs replacement.
PICC PICC Troubleshooting & Problem Resolution 1
A nurse attempts to flush a PICC line and encounters resistance.
What is the FIRST action the nurse should take?