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 -----
From: <mailto:[EMAIL PROTECTED]>Kelly Murphy
To: <mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED] ;
<mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED] ;
<mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED]
Cc: <mailto:[EMAIL PROTECTED]>[EMAIL PROTECTED]
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
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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
Email: [EMAIL PROTECTED]
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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
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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
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