In addition to these very good tricks, try using the "curve" of the cath to your advantage, if you have a PICC that continually goes up the neck raise the arm up and give yourself a straighter shot to the SVC. We also check our IJ with the ultrasound PRIOR to breaking down our sterile area and before x-ray to see if the cath is in the vessel. It will glow and is preyy simple to see. Bob
bOB >>> "Cheryl" <[EMAIL PROTECTED]> 2/27/2006 11:48:19 AM >>> 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
