Re: RE:Unable to get PICC into SVC

[dmam]

I personally have mixed feelings about this. I'm asked to do this but choose 
not to. We place our lines like dinosaurs (A/C & no ultra sound) so IR will not 
use my original site anyway. Not to mention that there is no written policy or 
procedure for this either.
 When a line does not make it in all the way (SVC) the excess has to coiled and 
placed under the dressing awaiting to inserted, this may make the insertion 
more prone to infection. Also if the line is looped or curled on it's self in 
the vein, would it not impede blood flow and possibly irritate vein (thinking 
Virchows triad here) setting up a possible thrombosis or embolis?
Thoughts or documents anyone?
Peter Marino RN BSN
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Leave the line as is and send to IR for readjustment if it can be done within 
12 to 24 hours ...Heather Nichols RN BSN CRNI 

 

I personally have mixed feelings about this. I'm asked to do this but choose not to. We place our lines like dinosaurs (A/C & no ultra sound) so IR will not use my original site anyway. Not to mention that there is no written policy or procedure for this either.

 When a line does not make it in all the way (SVC) the excess has to coiled and placed under the dressing awaiting to inserted, this may make the insertion more prone to infection. Also if the line is looped or curled on it's self in the vein, would it not impede blood flow and possibly irritate vein (thinking Virchows triad here) setting up a possible thrombosis or embolis?

Thoughts or documents anyone?

Peter Marino RN BSN

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Leave the line as is and send to IR for readjustment if it can be done within 12 to 24 hours ...Heather Nichols RN BSN CRNI

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 are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited.  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. -----------------------------------------------------