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I am confused. When is it appropriate to "pull back
to subclavian placement"? My understanding is that midclavicular is never
appropriate placement.
Halle Utter, RN, BSN
----- Original Message -----
Sent: Saturday, October 14, 2006 8:19
AM
Subject: Re: Malposition
Okay,
we JUST had something like this happen yesterday. It wasn't due to power
injection, but nonetheless, it made us rethink some things.
A
gentleman came in with a PICC I had inserted in the beginning of August.
Apparently he had gotten a one or two doses of chemo before he was
admitted. He had heparin running since admission. The PICC was out
1 cm from my insertion record, so I ordered a CXR to confirm placement.
Low and behold, the tip was up the IJ!! Well, as you can imagine, my
mind started going in circles. I contacted his heme/onc CRNP and we
decided, at this point, to pull it back to subclavian placement so he could
continue to get his meds for the weekend, and come Monday, we'd figure out
what we wanted to do. She asked why he couldn't get chemo with
subclavian placement, and I explained what it could do to the vein, comparing
it to as bad or worse than what Vanco will do to a subclavian with prolonged
treatment. She understood and I need to have a plan of action for Monday
morning of what I want to do with this guy.
Background:
he has lymphoma in his abdomen (this is what I was told). I don't
believe the first insertion was traumatic (I remember his name, but nothing
specific, telling me it went smooth), meaning he had veins.
What
is everyone's suggestion? Do an exchange or insert a whole new PICC in
the other arm? Like I said, I need your help so that I can go back in on
Monday with something to tell the heme/onc people with a rationale. They
are usually very receptive to what we want, so it won't be a hard sell, I just
want to be prepared.
Also,
this made me think that there should be some protocol to reconfirming PICC
placement, but how often is often enough? This patient was just
admitted, but we can probably assume that his last chemo treatment went up his
IJ.
Thanks
in advance,
Kelly
-----
Original Message ---- From: "[EMAIL PROTECTED]"
<[EMAIL PROTECTED]> To: [EMAIL PROTECTED];
[EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Sent: Friday, October 13,
2006 10:42:55 PM Subject: Re: Malposition after power injection
I had also heard that the distal end of the Power PICC was the same
as the Poly Per-Q-Cath, and I wondered how we can be confident that it
will not migrate out of the SVC. I have seen it happen with the Poly PQC with
movement.
Paul makes a good point about making sure the tip is in the
lower SVC. This is not something we can count on radiology techs to
consider. If a power injectable PICC is in mid or upper SVC, it
probably should not be left in place, as it will be assumed that it can
be used for pressure injection.
Leigh Ann -----Original Message----- From:
[EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc:
[EMAIL PROTECTED] Sent: Fri, 13 Oct 2006 3:11 PM Subject: RE: Malposition
after power injection
I wouldn’t think so.
You have gravity working in your favor when you are attempting to flush the
tip out of the IJ. Also from what I understand, the composition and dimensions
of the Power PICC catheter body is the same as the Poly Per-Q-Cath (it was
beefed up in the hardware of the hub, Y-section and extensions to cope with
the pressure of the speed injectors) so should respond to that procedure in
the same way as a Poly Per-Q-Cath.
Regards,
Dianne
Sim RN
CEO &
President
IV Assist,
Inc.,
2675 Appian
Way
Pinole, CA
94564
Phone: (510)
222-8403
Fax: (510)
222-8277
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attachments.[v1.0]
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Roger
Soriano
Sent: Thursday,
October 12, 2006 7:21 PM
To:
Blackburn, Paul
Cc:
[EMAIL PROTECTED]; Nadine Nakazawa; [EMAIL PROTECTED]; [EMAIL PROTECTED];
Kokotis, Kathy
Subject: Re:
Malposition after power injection
So does this mean that the POWER PICC is
not easily flipped when it is inadvertently placed in the
IJ??
Susan, Nadine,
Dennis, et al
The Bard PowerPICC
was designed and tested to ensure that the catheter tip does not whip about
during power injection of contrast media. The catheter in fact may back
up slightly (about 1cm), but does not whip about in the SVC during
injection. The testing was done in a model that simulates normal human
body temperature, blood flow and pressures. The contrast media that was
used for the testing was the most viscous product available on the
market. The testing was conducted on many catheters over the course of
several days. In other words, the catheter was in place in this
simulated human environment for nearly two weeks, with power injection of
contrast media taking place daily. So in reality the testing simulated
conditions that would be found in the patient care environment, outside of the
fact that very few patients would recieve power injection of contrast media on
a daily basis. With that being said, we did not see the catheter soften
or flex enough to flip into another vessel--unless the catheter was not
properly situated in the first place. In other words, if the catheter
tip is located any where from the lower 1/3 of the SVC to the Caval/Atrial
junction, it does not leave the SVC even with repeated power injections over
the course of serveral days. To that end, I don't believe the Bard
PowerPICC will malposition merely because of the injection of contrast
media.
Hope this helps to
explain things a little. Please let me know if you have additional
questions or need more detail. Paul
Paul L. Blackburn,
RN, MNA
Manager, Clinical
Education
Office:
800-443-5505, ext. 4981
Mobile:
801-598-1657
Confidentiality Notice:
This e-mail and any attachments are intended only for the use of those to whom
it is addressed and may contain information that is confidential and
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in error, its review, use, retention and/or distribution is strictly
prohibited. If you are not the intended recipient, please contact the sender
by reply e-mail and destroy all copies of the original message and any
attachments.[ v1.0]
Makes me wonder if this is something that was
considered and or studied by any of the
manufacturers.
--
Susan Schuetrumpf, CRNI
VASPRO
Atlanta,
GA
cell-404-606-1194
-------------- Original message --------------
From: "Nadine Nakazawa" <[EMAIL PROTECTED]>
>
> I was
wondering that once power PICCs have been out for awhile if we would
> see this phenomenon occur ---secondary malposition because of all
the
> whipping around. How deep to you place your original PICCs?
>
> Nadine Nakazawa
>
>
>
>
> >From: "DAVID LONGSETH"
> >To: [EMAIL PROTECTED]
> >Subject: Malposition after
power injection
> >Date: Wed, 11 Oct 2006 20:05:42 -0500
>
>
> >Saw a set of CXR's last week that were of interest. Pt had
a 5Fr Power PICC
> >placed in the AM,then a CT in the afternoon
(chest for PE,I think). Later
> >in the evening pt. began having
discomfort and swelling in the neck. CXR
> >af ter PICC placed
showed a good lower SVC placement but the evening's film
> >showed
the line up the IJ,perhaps with the tip in smaller collateral vein.
>
>Apparently the CT contrast injection was strong enough to flip the PICC
up
> >there.
> >Was wondering if anyone else has seen
this occur,but then also wonder if
> >this doesn't happen more
frequently and we just never know....
> >David
> >
> >
> >
>
>
>
--
Roger Soriano,
RN
Vascular Access Specialists
818-687-8348
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