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Wendy,
I am talking about the vessel, not the PICC itself. An infiltration/extravasation of med/fluid into the surrounding tissues when damage to the vessel becomes too great and a hole is created. The area that the tip of a midline/midclavicular line/PICC is in causes us to be unable to visualize this till the damage is extensive. It very rarely happens with PICCS, but midlines that are used to infuse extreme irritants or vesicants cause this a lot. MIDCLAVICULAR are even worse. Rupture of the line itself is not the issue. Tip position is the issue. You need high rates of blood flow to properly hemodilute drugs/fluids, such as contrast, to help decrease the possibility of vessel wall damage due to irritation from many different things (the catheter itself, the med/fluid, catheter movement, power injection, ECT). All of these things, plus more, can cause deterioration of the vessel wall if the blood flow is not adequate. The only place for this to be adequate is the SVC or right atrium, depending who you ask, and what it is for. Does that help. Maybe I misunderstood the question. Sorry if I did.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Erickson, Wendy" <[EMAIL PROTECTED]> 3/8/2006 9:44 AM >>> I think I am missing something here. How would a midline/PICC
infiltrate/extravasate? Have you actually seen PICCs go thru a vessel into the subq tissues? I am not clear as to how this would happen. You enter the vessel well below where the tip is located, you get a blood return, you have an xray confirming correct placement. If a pressure infusion ruptures a catheter, the fluid would leak out into the blood stream. The only way I can visualize this happening is an actual rupture of the vessel itself, or somehow the PICC passes thru the vessel wall? I have never considered infiltration of a PICC a possibility, unless the PICC has been pulled almost all of the way out of the vessel and is in that small space between the level of the skin and the vessel itself. And if that is the case, I can't imagine anyone in their right mind using it for anything! Please clarify this for me - how can a true infiltration occur? Thanks! Wendy Ericksoon RN Luther Midelfort - Mayo Health System Eau Claire WI -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Heather Nichols Sent: Wednesday, March 08, 2006 7:32 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE:Unable to get PICC into SVC 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 MD's 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 ----------------------------------------------------- Confidentiality Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you receive this message in error, or are not the named recipient(s), please notify the sender or contact the University of Louisville Health Care I.S. helpdesk at 502.562.3637 to report an inadvertently received message. ********************Confidentiality Notice******************** This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Any unauthorized review, use, disclosure or distribution of this email message, including any attachment, is prohibited. If you are not the intended recipient, please advise the sender by reply email and destroy all copies of the original message. Thank you.
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