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Leave the line as is and send to IR for readjustment if it can be done within 12 to 24 hours, or remove and try another site. The line should not be used until it is in good tip position. If it is pulled back and left as a midline, nothing should be given through it that you cannot give through a regular peripheral IV site. Infiltrations are particularly hard to see with a midline until it is too late. At least with a peripheral IV site, you can usually see it happen right away. Midclavicular are bad news. An infiltration or, God forbid, an extravasation, will not be seen until the damage has been done, and the damage will be in the subclavian. You only have one on each side. It is not like the extremities where we have plenty to ruin. We actually had midclavicular line removed from our Kentucky state boards decision tree and opinion statements with no problem since there was tons of evidence to show how dangerous midclavicular lines were. Let your doc's know about this. They probably have no idea.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Patty Flack" <[EMAIL PROTECTED]> 3/5/2006 2:39 PM >>> I had a patient last week in ICU who had a PICC line ordered, but PICC kept going into the IJ after 3 attempts to get it to go SVC. I ended up pulling the PICC back to a Midclavicular tip placement. This hospital does not have IR and the infusates were irritating in nature. I have come across this situation in the past and have been directed by MDs to leave the line Midclavicular. My supervisor says to always pull back to midline and schedule patient for IR. I would like to know the opinion of those who are more experienced than I. Thank you in advance, Patty Flack RN
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