Try these things to help the PICC from advancing up the jugular with
placement.
1- Thread a cm a second when the PICC gets to the axillary area. Many
times, the nurses will thread with a 2-3 inch advancement and if the PICC
just happens to head to the neck, it just keeps on going. By threading a cm
a second, when the catheter gets to this junction, hopefully the blood flow
from the subclavian will take it south towards the SVC. There is 1600 cc of
blood per minute in the subclavian vein.
2- Pull the wire back about 4 inches or so when it gets to the axillary
area. This will make the tip somewhat "floppy" (more so for silicone that
poly) and help allow it to "fall" to the SVC.
3- Try "floating" the PICC when getting to the axillary area. I will
connect a 10cc syringe and give a continuous flush of saline while threading
across the subclavian. It is a steady flush and continues until I get past
the junction of the jugular and the SVC.
4- Try to "sense" where you are with the PICC. After threading many of
these lines, I can get a feeling of the junction of the jugular and the SVC.
When I feel this little "pause" then I know I am at the junction of the jug
and SVC and I check for blood.....if it comes very freely, then I go ahead
and advance. If there is even the slightest pause, then I pull back 4 cms
and rethread.
5- The ole' trick of turning the head towards you, yes, I still do that.
But keep in mind......this trick will not routinely keep the PICC from
advancing up the jugular, but it will give you the "feel" that this action
has occurred.
Good Luck.
Cheryl Kelley
West Virginia University Hospitals
[EMAIL PROTECTED]
304-823-3196
304-669-3061
