Unable to get PICC into SVC

[Cheryl]

Many PICC teams leave tips NOT in the SVC.  They look at the infusate and then decide that if the pH is OK and the osmolality is OK, then things will be OK. Please consider the following.......   A problem that is not considered by this practice is what occurs when the tip of the PICC comes in contact with the intima of the vessel.  One factor in Virchow's Triad of Stasis is intima condition and how it can lead to thrombus.  The intima is one cell thick endothelial layer, and the PICC hitting the top and bottom of the vessel will damage this layer and set up a perfect scenario for thrombus.  Add to that the fact that  with arm movement, the tip moves inside the vessel, and you then have damaged it further.   Because of these problems, it is NEVER  in my practice to leave a tip in any vein except the SVC.  If the PICC will not advance into the SVC, then the patient does not have a PICC anywhere from the axillary over!   Irritating meds indeed can irritate the intima, but perhaps most importantly, intima damaged from movement of the tip will irritate it more.     Cheryl Kelley West Virginia University Hospitals [EMAIL PROTECTED] 304-823-3196 304-669-3061