Insertion Techniques & Complications Management Flashcards

A patient with a newly placed tunneled CVC develops fever, chills, and erythema along the tunnel tract 8 days post-insertion. Which management is MOST appropriate?

Answer: Remove the catheter and initiate systemic antibiotics

Tunnel tract infection extending more than 2 cm from the exit site requires catheter removal along with systemic antibiotic therapy.

When performing internal jugular vein cannulation, the needle is inserted at the apex of the triangle formed by the two heads of the sternocleidomastoid muscle. In what direction should the needle be angled?

Answer: Laterally away from the carotid artery at 30–45 degrees toward the ipsilateral nipple

The needle is directed laterally at 30–45 degrees toward the ipsilateral nipple to avoid the carotid artery and approach the internal jugular vein.

A post-procedure chest X-ray shows the tip of a CVC at the junction of the right atrium and superior vena cava. What is the MOST appropriate action?

Answer: Withdraw the catheter 1–2 cm to reposition the tip in the lower SVC

The ideal CVC tip position is in the lower one-third of the SVC; a tip at the SVC-RA junction should be withdrawn slightly to reduce arrhythmia and perforation risk.

Which complication is MOST associated with subclavian vein catheterization compared to internal jugular or femoral approaches?

Answer: Pneumothorax

The subclavian approach carries the highest risk of pneumothorax due to the proximity of the lung apex to the insertion site.

During a PICC insertion, the catheter advances with resistance after passing the shoulder. Which maneuver is MOST likely to resolve the issue?

Answer: Have the patient turn their head toward the ipsilateral shoulder and tuck their chin

Turning the head toward the ipsilateral shoulder and tucking the chin compresses the ipsilateral jugular vein, helping redirect the catheter into the SVC rather than up the jugular.

A patient develops sudden onset dyspnea, chest pain, and hypotension immediately after central line insertion. Breath sounds are absent on the right. What is the PRIORITY intervention?

Answer: Perform needle decompression of the right chest at the second intercostal space, midclavicular line

These findings are consistent with tension pneumothorax, a life-threatening emergency requiring immediate needle decompression without waiting for imaging.

Which of the following represents a Grade 4 phlebitis finding according to the INS Phlebitis Scale?

Answer: Pain, erythema, streak, palpable cord, and purulent drainage

Grade 4 phlebitis on the INS scale includes all classic signs plus purulent drainage at the site, indicating advanced infection.