RE: spontaneous picc tip malpositoning

[Dianne Sim]

The preference is to place a fresh line in the other arm, if possible. If not possible, you could perform an exchange, but only if the site is immaculate. If the patient has a silicone catheter in place and is ventilated, you may want to swap over to a polyurethane catheter which is slightly stiffer and may not malposition quite as easily. Hope this helps. Regards, Dianne Sim IV Assist, Inc Pinole, CA   From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Jennifer Kettle Sent: Thursday, March 09, 2006 4:31 PM To: [EMAIL PROTECTED] Subject: spontaneous picc tip malpositoning   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