Spontaneous catheter tip migration is well documented in the
literature and is usually caused by changes in the intrathoracic
pressure. Was your patient on a ventilator? Were they coughing,
sneezing, or vomiting? All of these in addition to congestive heart
failure and heavy lifting can lead to tip migration. I would feel
more comfortable with repositioning this PICC that leaving it in the
subclavian. You did not say what was infusing but the subclavian is
the least favorable option in my opinion Lynn
At 4:30 PM -0800 3/9/06, Jennifer Kettle 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
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
