Insertion Techniques & Complications Management Flashcards
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Read the first 7 Insertion Techniques & Complications Management flashcards as text
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?
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.
A patient develops a hematoma at the PICC insertion site immediately after insertion. Which action is the MOST appropriate initial response?
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.
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?
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.
Which of the following is the correct sequence for the modified Seldinger technique used in PICC insertion?
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.
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?
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.
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:
Answer: Extravasation
Extravasation is the inadvertent leakage of a vesicant or irritant medication into surrounding tissue, causing potential tissue necrosis.
Which vein is considered the PREFERRED target for ultrasound-guided PICC insertion in adult patients?
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.