VABC Complication Management 3 — Questions and Answers
Question 1: When treating catheter-related thrombosis in an upper extremity PICC, what is the preferred initial anticoagulation agent according to current guidelines?
- Unfractionated heparin IV infusion
- Low molecular weight heparin (LMWH) or direct oral anticoagulant (DOAC) (Correct answer)
- Warfarin initiated immediately
- Thrombolytic therapy with alteplase
Correct answer: Low molecular weight heparin (LMWH) or direct oral anticoagulant (DOAC)
Current guidelines recommend LMWH or DOACs as first-line anticoagulation for upper extremity DVT related to vascular access catheters.
Question 2: A nurse notes that a PICC line appears to have advanced several centimeters since the last documented length. What is the priority action?
- Flush the line and continue using it
- Obtain a chest X-ray to verify tip position before use (Correct answer)
- Pull the line back to the original external length and use it
- Discontinue the PICC and insert a new one
Correct answer: Obtain a chest X-ray to verify tip position before use
Any change in catheter external length requires radiographic tip position confirmation before the line is used, as migration into the heart is dangerous.
Question 3: Which clinical sign most strongly suggests superior vena cava (SVC) syndrome as a complication of a long-term central venous catheter?
- Unilateral arm edema on the catheter side
- Bilateral facial and upper extremity edema with venous distension (Correct answer)
- Fever and chills with positive blood cultures
- Hemothorax on chest X-ray
Correct answer: Bilateral facial and upper extremity edema with venous distension
SVC syndrome causes bilateral facial and upper extremity edema plus prominent neck and chest wall venous collaterals due to obstruction of the superior vena cava.
Question 4: A patient develops chylothorax following left-sided central venous catheter insertion. Which structure was most likely injured?
- Left subclavian vein
- Thoracic duct (Correct answer)
- Left internal mammary artery
- Left pleural space
Correct answer: Thoracic duct
The thoracic duct runs near the left subclavian-jugular venous junction, and injury during left-sided CVC insertion can cause lymphatic leakage (chylothorax).
Question 5: A patient receiving vesicant chemotherapy through a peripheral IV develops swelling and burning pain at the infusion site. What is the immediate action?
- Slow the infusion rate and apply a warm compress
- Stop the infusion, aspirate residual drug, and remove the IV without flushing (Correct answer)
- Flush the line with normal saline to dilute the drug
- Apply ice and continue the infusion through a new site
Correct answer: Stop the infusion, aspirate residual drug, and remove the IV without flushing
With vesicant extravasation, the infusion must stop immediately, any residual drug should be aspirated through the existing catheter, and the IV removed without flushing to avoid spreading the vesicant.
Question 6: What is the recommended dwell time limit for peripheral IV catheters in adult patients to minimize phlebitis risk per INS standards?
- 24 hours
- 72-96 hours based on clinical assessment (Correct answer)
- 48 hours strictly
- 7 days with proper care
Correct answer: 72-96 hours based on clinical assessment
INS standards recommend replacing peripheral IV catheters every 72-96 hours in adults or sooner if signs of complications appear.
Question 7: A patient develops hematoma formation immediately after PICC removal. Which vessel injury is the most common cause?
- Accidental arterial cannulation of the brachial artery during insertion
- Venous back-bleeding from the basilic or cephalic vein (Correct answer)
- Lymphatic injury causing lymphedema
- Nerve injury causing vascular dilation
Correct answer: Venous back-bleeding from the basilic or cephalic vein
Venous back-bleeding from the access vein is the most common cause of hematoma after PICC removal; firm direct pressure for several minutes is required.
VABC Complication Management 3
When treating catheter-related thrombosis in an upper extremity PICC, what is the preferred initial anticoagulation agent according to current guidelines?