I had already planned on replacing it since I have NEVER had success repositioning by flushing. I was asking exchange or new site, but thank you for your response.
Kelly --- [EMAIL PROTECTED] wrote: > Even when a PICC repositions to the IJ, we have had > success in getting it back to SVC by sitting the > patient up and flushing with saline. We would not > have pulled the line back to subclavian. We never do > that, regardless of what is infusing. Since you have > already pulled the line back, I would replace it at > this point. > Leigh Ann > > > -----Original Message----- > From: [EMAIL PROTECTED] > To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; > [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED] > Sent: Sat, 14 Oct 2006 10:19 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 wouldnʼt 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 > Email: [EMAIL PROTECTED] > > > > 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 prohibited from further > disclosure under law. If you have received this > e-mail 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] > > > > 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?? > On 10/12/06, Blackburn, Paul < > [EMAIL PROTECTED]> wrote: > 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 > Email: [EMAIL PROTECTED] > > > > > > > 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 prohibited from further > disclosure under law. If you have received this > e-mail 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] > > > > > > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] On Behalf Of > [EMAIL PROTECTED] > Sent: Thursday, October 12, 2006 11:20 AM > To: Nadine Nakazawa; [EMAIL PROTECTED]; > [EMAIL PROTECTED] > Subject: RE: Malposition after power injection > Makes me wonder if this is something that was > considered and or studied by any of the > manufacturers. > Paul????Are you reading? > > > -- > 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 > > CONFIDENTIALITY NOTICE: > This e-mail message, including all attachments, > is for the sole use of the intended recipient(s) and > > may contain confidential and privileged information. > If you are not the intended recipient, you may NOT > use, disclose, copy or disseminate this information. > > Please contact the sender by reply e-mail > immediately and destroy all copies of the > original message including all attachments. > Your cooperation is greatly appreciated. > > > Check out the new AOL. 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