Peripherally Inserted Central Catheter and Central Line (15 Questions)

1. You are working on a medical unit caring for Mr. Tremblay, a 67-year-old patient admitted for osteomyelitis requiring long-term intravenous antibiotic therapy. A specialized vascular access nurse has just inserted a PICC line in the patient's right upper arm. The nurse has secured the device and applied a sterile dressing. You have an order to administer the first dose of Vancomycin immediately.

Question:
What is your absolute priority before connecting the IV tubing and starting the infusion? *

Flush the line with 10 mL of normal saline using the push-pause technique to ensure patency.

Measure the external length of the catheter and compare it to the insertion note to ensure it has not migrated.

Assess the insertion site for immediate signs of bleeding or hematoma formation.

Verify that a chest X-ray has been performed and the radiologist has confirmed the catheter tip is in the Superior Vena Cava (SVC).

2. You are changing the injection caps (needleless connectors) on Mrs. Gauthier’s triple-lumen central venous catheter. The patient is sitting in a semi-Fowler’s position. Suddenly, as you disconnect the old cap from the lumen, Mrs. Gauthier gasps, grabs her chest, becomes cyanotic, and her blood pressure drops to 80/50 mmHg. You suspect an air embolism.

Question:
To prevent the air from entering the pulmonary circulation, what is the immediate positioning intervention? *

Place the patient in a high-Fowler’s position and administer high-flow oxygen.

Lay the patient flat (supine) and elevate the legs to increase venous return.

Place the patient in the Trendelenburg position on her left side.

Position the patient on her right side with the head of the bed elevated 30 degrees.

3. You are preparing to perform a sterile dressing change on Mr. Roy’s PICC line. He has been hospitalized for 2 weeks. You have set up your sterile field, donned a mask, and asked the patient to turn his head away from the site. You are now preparing to cleanse the skin around the insertion site.

Question:
Which technique describes the correct application of the Chlorhexidine-based antiseptic agent? *

Apply the solution in a circular motion, starting at the insertion site and moving outward in widening circles.

Apply the solution using a back-and-forth friction scrub motion for at least 30 seconds, cleaning the site and surrounding skin.

Dab the solution gently around the insertion site to avoid dislodging the catheter.

Apply the solution only to the area where the transparent dressing will adhere, avoiding the insertion site itself.

4. You need to flush the distal lumen of Mrs. Lefebvre’s central line before administering a medication. You attach a 10 mL syringe of normal saline. As you attempt to push the plunger, you meet significant resistance and cannot instill the fluid.

Question:
To ensure patient safety and preserve the line, what is the appropriate nursing action? *

Apply firm, steady pressure to the plunger to clear the potential clot.

Switch to a 3 mL syringe to generate more pressure and dislodge the obstruction.

Ask the patient to cough and change position, then gently attempt to flush again.

Immediately instill a thrombolytic agent (like Alteplase/Cathflo) to dissolve the clot.

5. Mr. Dubé, a 55-year-old patient, is being discharged today. The physician has ordered the removal of his PICC line. You have explained the procedure to the patient and positioned him supine. You are ready to withdraw the catheter.

Question:
What instruction must you give the patient during the actual moment of withdrawal to prevent an air embolism? *

"Take shallow, rapid breaths (panting) while I pull the line out."

"Breathe normally and try to relax your shoulder muscles."

"Exhale fully and empty your lungs completely before I start."

"Take a deep breath and hold it while I pull the line out."

6. You are caring for Mrs. Gagnon, who has a PICC line in her left basilic vein for Total Parenteral Nutrition (TPN). During your shift assessment, you measure the external length of the catheter and note that 5 cm is visible. The documentation from the insertion states that 2 cm was visible externally.

Question:
What is your interpretation of this finding and the required action? *

The catheter has migrated outward; do not use the line and notify the physician for an X-ray.

The catheter has migrated outward; secure it at the new length and continue to use it.

The catheter has migrated inward; pull it back 3 cm to match the original measurement.

This is a normal variation due to arm movement; no action is required.

7. You are preparing to administer an IV push antibiotic to Mr. Caron, who has a PICC line. You have scrubbed the hub and are selecting the syringe for the saline flush. The hospital is currently out of pre-filled saline syringes, so you must draw it up manually.

Question:
Why is it mandatory to use a syringe with a barrel size of 10 mL or larger when flushing a PICC or Central Line, even if the volume needed is small? *

To ensure there is enough saline to fully clear the medication from the long catheter.

To make it easier to aspirate blood for patency checks.

To prevent excessive pressure (PSI) that could rupture the catheter lumen.

To ensure the turbulence is sufficient to clean the fibrin from the walls.

8. Mrs. St-Pierre is receiving Total Parenteral Nutrition (TPN) with lipids through the distal lumen of her central line. She also has an order for IV Pantoprazole (Protonix). You have verified that Pantoprazole is incompatible with TPN.

Question:
How should you administer the Pantoprazole? *

Stop the TPN, flush the line, administer the medication, flush again, and restart the TPN.

Start a peripheral IV line specifically for the Pantoprazole to avoid infection risks.

Piggyback the Pantoprazole into the TPN tubing at the lowest Y-site port.

Administer the Pantoprazole through the proximal or medial lumen of the same central line.

9. You are the charge nurse observing a new graduate nurse drawing blood for laboratory analysis from a patient's PICC line. The nurse stops the infusions, scrubs the hub, and attaches a 10 mL syringe.

Question:
Which action by the new graduate would require you to intervene and provide corrective teaching? *

The nurse flushes the line with 10 mL of normal saline before drawing blood.

The nurse withdraws 5 mL of blood and discards it in the biohazard bin before drawing the sample.

The nurse withdraws the required blood sample immediately without a discard (waste) draw.

The nurse flushes the line with 20 mL of normal saline using a push-pause method after the draw is complete.

10. You have just removed a central venous catheter from Mr. Boisvert's right subclavian vein. Upon inspection of the removed device, you notice that the catheter tip appears ragged and is shorter than the documented length. You suspect a catheter embolism (a piece of the catheter has broken off inside the patient).

Question:
What is the priority nursing intervention? *

Apply a tourniquet to the patient's right arm.

Place the patient in the left lateral Trendelenburg position.

Apply a warm compress to the insertion site to promote vasodilation.

Prepare the patient for an immediate MRI to locate the fragment.

11. You are precepting a novice nurse on the oncology unit. You are caring for Mr. Lavoie, a 45-year-old patient with a right subclavian central venous catheter. He has just finished a cycle of chemotherapy. The novice nurse prepares to flush the catheter with normal saline and asks you why you are teaching her to use a "push-pause" (pulsatile) motion on the syringe plunger rather than a steady, continuous push.

Question:
Which explanation provides the correct scientific rationale for this technique? *

"It prevents the tip of the catheter from whipping against the vein wall, which can cause arrhythmia."

"It reduces the internal pressure (PSI) within the catheter to prevent rupture of the silicone."

"It allows time for the nurse to assess for pain or resistance during the injection process."

"It creates turbulence within the catheter lumen, which helps remove fibrin sheaths, sludge, and medication residue."

12. Mrs. Bédard, 62, is receiving Total Parenteral Nutrition (TPN) with lipids (intravenous fat emulsion) via her PICC line due to severe malabsorption syndrome. You are performing a safety check of the equipment at the beginning of your shift at 08:00. You note that the current TPN administration tubing and bag were hung yesterday morning at 07:00.

Question:
Based on infection control standards for lipid-containing solutions, what is your priority action? *

Continue the infusion; the tubing is good for 72 to 96 hours like standard IV fluids.

Change the bag of TPN but leave the tubing, as it contains an in-line filter that protects the patient.

Immediately prepare a new bag and administration set and change them, as the hang time has exceeded the safety limit.

Reinforce the dressing, as the risk of infection comes from the insertion site, not the tubing.

13. Mr. Giroux, a 70-year-old patient with a left subclavian central line, calls because his IV pump is alarming "Occlusion." When you enter the room, the patient is sitting upright in a chair eating breakfast. You assess the line and find it flushes easily when he lies flat in bed, but the pump alarms immediately when he sits up and moves his shoulder forward.

Question:
What condition do these assessment findings suggest ("Pinch-off Syndrome"), and what is the appropriate action? *

It indicates a thrombus at the tip; administer a thrombolytic agent.

It indicates the catheter is being compressed between the clavicle and the first rib; notify the physician for an X-ray evaluation.

It indicates the catheter is kinked under the dressing; remove the dressing and re-secure the line.

It is a pump malfunction; switch the administration set to a gravity feed.

14. Mrs. Fortin, 55, has had a PICC line in her right upper arm (basilic vein) for 10 days for antibiotic therapy. She calls you to the bedside complaining of a dull ache in her right arm and shoulder. Upon assessment, you note the right arm circumference is 3 cm larger than the left arm, and the skin appears slightly mottled. The insertion site itself is clean and dry.

Question:
What complication do you suspect, and what is the immediate nursing intervention? *

Infiltration of the antibiotic; apply a warm compress and elevate the arm.

Phlebitis; slow the infusion rate and apply a cold compress.

Deep Vein Thrombosis (DVT); stop the infusion immediately and immobilize the arm.

Lymphatic congestion; encourage the patient to perform range-of-motion exercises.

15. You are caring for Mr. Cloutier, a patient with a triple-lumen central line. He suddenly develops rigors (shaking chills) and a temperature spike to 39.5°C roughly 15 minutes after you flushed the catheter. The insertion site looks clean, with no redness or purulent discharge.

Question:
You suspect a Central Line-Associated Bloodstream Infection (CLABSI). To confirm the diagnosis accurately, how should the blood cultures be drawn? *

Draw one set of cultures from the central line and start broad-spectrum antibiotics immediately.

Draw one set of cultures from a peripheral vein and one set from the central line (all lumens).

Draw two sets of cultures from two different peripheral veins.

Remove the central line immediately and send the tip for culture; do not draw blood.