Halle,
 
I had a case like this, but in my case the tip of the catheter wasbroken off when the line was d/c'd.  the patient went to the hospital because the PICC that came out was 42cm and the length I recorded was 48cm.  They were unable to see the catheter on xray because it was 4fr and the patient was heavy, so it did not show up.  The ER Dr. decided that I recorded the wrong lenth and sent the patient home.  I spoke to this patient about 6 months later and he told me what had happened and I told him that he had about 6cm of cathter still in him and to remember this because it would probably come up in the future...6 months after this, I had a cardiologist approch me and ask me "do you remember Mr. so-n-so" and I said.."you found the rest of my catheter!"  Sure enough, the patient was admitted with an arrythmia and they did a TEE on him and this allowed them to see the catheter.  They took the patient to specials and used a snare to remove it.  Very interesting case!  Of course it went to risk management.
 
I don't see any other way a PICC could be responsible for an arrythmia 3 years later.
 
Dave R.N.
----- Original Message -----
Sent: Wednesday, October 11, 2006 10:25 AM
Subject: PICCS and arrythmias YEARS after PICC placement

Has anyone heard of a PICC tip being in the RA for a few minutes at the time of placement before being pulled back to the SVC after CXR showed it was in the RA being responsible for the patient developing SVT later?  I have a pt complaining that his SVT now was caused by a PICC 3 years ago because the tip dipped into the atrium?  The line was pulled back to lie in the SVC after CXR showed tip in RA.  This was a silicone catheter, not trimmed, full 60 cm length.  Placed before we used ultrasound, at the antecubital area. Line was placed in 2003.  Diagnosis was neutropenia.  I don't know rest of history, but patient's doctor told him the reason he is having episodic SVT now is due to a PICC line placed 3 years ago.  Of course a floppy tip in RA could cause an arrythmmia at the time of placement, but has anyone ever heard of arrythmmias developing down the road from a PICC? 
 
Halle Utter, RN, BSN
 

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