You're right- repositioning is not a solution-this would be inviting a catheter-related infection. Pulling a central catheter back to subclavian is asking for venous thrombosis (stats indicate up to 60% increase with midclavicular tip placement). We no longer perform catheter exchanges (except in the rare circumstance where there are no other options & everyone-pt, nurse, MD are aware of the risks & vigilantly assessing for signs of thrombosis, extravasation). The main risk with catheter exchanges is infection. There is likely a microbial biofilm adhered to the catheter- when you remove the catheter you may shear off the microbial biofilm & seed the new catheter.
You may want to wait a day- tincture of time will sometimes bring tip down (especially if its a small silicone catheter- although unlikely in ICU). Some have infused slow NS drip (i.e., 20cc/hr- although not sure that there would be much evidence to support
this).
Best option would be to remove the line & put new line in a new vein (if possible).
If this isn't feasible, may consider retracting the line to a midline, as long as the infusate(s) meet the midline criteria (pH neutral, near-isotonic, non-vesicant/irritant, <2-4 weeks )duration).
Daphne Broadhurst
Ottawa ON
Jennifer Kettle <[EMAIL PROTECTED]> wrote:
Jennifer Kettle <[EMAIL PROTECTED]> wrote:
I have another question. Usually, I am a quiet lurker/learner but have had some concerns come up lately. I have come to learn that I can trust your input and thanks for that, by the way. We have had a patient in the ICU come up with a spontaneously malpositioned picc line up the IJ when it was in the SVC after insertion and everyday following until now. Had been in about a week when this happened. My colleague tried a power flush as well as patient position changes, etc. which had no effect. She finally ended up just pulling the picc back to a subclavian tip position, after speaking with the MD. Just felt uncomfortable about doing an entire repositioning when it had been in for so long. What do you guys suggest would be the best approach to this problem? Do we need to do an entirely new picc or could we have repositioned it at that time instead of pulling back? Anyhow, thanks in advance.Jenny Kettle, RN, BSN
