WEEK 4: Peripherally Inserted Central Catheter (PICC): Removal (Canada Nurse)

Question 1

What is a venous air embolism?

Answer 1

A potentially life-threatening complication that can occur during or after catheter removal

Signs and symptoms include respiratory distress, agitation, cyanosis, gasp reflex, sucking sound, hypotension, petechiae, cardiac arrhythmias, and change in mental status.

Question 2

What is a PICC?

Answer 2

A radiopaque central venous access device inserted peripherally, usually into the basilic or cephalic vein

It is used for administration of fluids, medications, prolonged antibiotic therapy, parenteral nutrition, blood products, and chemotherapy.

Question 3

What are the lumen configurations available for a PICC?

Answer 3

• Single-lumen
• Double-lumen
• Triple-lumen

Double lumens are preferred for simultaneous uses.

Question 4

True or false: An air embolism can occur during or after the removal of the catheter.

Answer 4

TRUE

Air can be drawn into the vein along the subcutaneous tract.

Question 5

What should be done if a patient is receiving anticoagulation therapy during catheter removal?

Answer 5

Apply pressure longer if necessary

This is to prevent complications related to bleeding.

Question 6

What should be explained to the patient and caregiver(s) before catheter removal?

Answer 6

• Explanation of equipment and procedure
• Importance of remaining still
• Importance of remaining supine flat for 30 minutes post-removal

Instruct to report shortness of breath, bleeding, or discomfort.

Question 7

What are the steps for assessment before removing a PICC?

Answer 7

• Perform hand hygiene
• Identify patient with two identifiers
• Confirm provider’s prescription
• Assess catheter exit site
• Review medical history and lab results

Assess for bleeding disorders and contraindications.

Question 8

What is the position of the patient during catheter removal?

Answer 8

Supine flat or Trendelenburg position

This ensures the insertion site is below the level of the heart.

Question 9

What should be done if the catheter has sutures?

Answer 9

Remove sutures while maintaining aseptic technique

This is part of the catheter removal procedure.

Question 10

What is the Valsalva manoeuvre used for during PICC removal?

Answer 10

To prevent air embolism

Instruct the patient to perform it unless contraindicated.

Question 11

What are the expected outcomes after catheter removal?

Answer 11

• Catheter removed without difficulty
• Patient calm and comfortable
• Catheter removed intact
• Hemostasis achieved

These outcomes indicate a successful procedure.

Question 12

What are some unexpected outcomes during catheter removal?

Answer 12

• Inability to remove catheter
• Catheter not removed intact
• Venous air embolus
• Persistent bleeding
• Hematoma
• Patient anxious and uncomfortable

These outcomes require immediate attention.

Question 13

What should be documented after catheter removal?

Answer 13

• Date and time of removal
• Condition of catheter insertion site
• Intactness and length of removed catheter
• Patient’s tolerance of the procedure

Document pain assessment, vital signs, and patient education.

Question 14

What special considerations should be taken for pediatric patients during catheter removal?

Answer 14

• Explain procedure to caregiver(s)
• Consider child’s developmental level
• Additional nurses or adults may be needed

This ensures the procedure is adapted to the child’s needs.

Question 15

What should be considered for gerontologic patients during catheter removal?

Answer 15

Extra care due to dry, thin, and fragile skin

This is important to prevent skin damage.

Question 16

What should be arranged if catheter removal is necessary after the patient returns home?

Answer 16

A visit from a home health nurse

This ensures proper care and monitoring post-removal.

Question 17

After the removal of a PICC, the patient becomes hypotensive, lightheaded, confused, tachycardic, anxious, and short of breath. What should the nurse do next?

Answer 17

The nurse should suspect the patient has a venous air embolism and should immediately place the patient in the left lateral Trendelenburg position; this helps prevent air from traveling through the right side of the heart into the pulmonary arteries, leading to right ventricular outflow obstruction (air lock).

Question 18

While discontinuing a PICC, the nurse meets resistance and the catheter appears stuck. What should be the nurse’s next action?

Answer 18

If resistance is met while discontinuing a PICC, the procedure should be stopped and the health care provider should be notified.

Question 19

Upon removal of a PICC, the nurse notices that the catheter length is less than the original insertion length. What should the nurse do first?

Answer 19

f a discrepancy between insertion length and removal length is identified, this indicates the tip of the catheter may have broken off during removal and a fragment retained in the patient; the nurse should immediately notify the health care provider.

Question 20

Before removing a PICC from a patient that the Valsalva manoeuvre is contraindicated, the nurse should give what instructions to the patient?

Answer 20

When removing a PICC from a patient in which the Valsalva manoeuvre is contraindicated, the nurse should instruct the patient to take a deep breath and hold it; this action prevents complications associated with air emboli.

Question 21

A nurse is providing a patient with instructions about PICC removal. The nurse knows the patient understood the postprocedure instructions when they make which of the following statements?

Answer 21

Following removal of the catheter, the patient should stay in the supine flat position for 30 minutes.