We have been having more coiled PICC lines that need to be refered to Intervention Radiology for PICC line exchanges. How can me and fellow PICC line nurses repair them ourselfs.
What are you finding out when you go to IR? They are actually having to exchange? They cannot straighten it with a wire and watching it on Fluoro? If they are finding DVT/stenosis and they can't advance it either, your "solution set" is different than if they are just advancing it with their fancy wires.
If you are just curled in the axillia, or up in the neck, or even looped in the SVC, there are numerous things you can try, depending on your hospital policy.
While you are advancing the catheter, periodically check for blood return. This will give you a heads up in terms of what is going to be shown on your CXR. If we lose our blood return during advancement, we try to problem solve to the best of our ability prior to the CXR. Almost always, (although I have seen it happen) you won't get a return when your cath has looped, folded, coiled, bent.
Coils and loops can be related to anatomic variations, so in a way managing the "roadways" of the vessels helps to give the catheter and wider road with less side streets. To that end, the various tips for advancement help decrease the chance of looping, etc. Also, getting a good hx prior to starting may help make decision about which side to put the picc in and what techniques to utilize for success.
Here are a couple tips. (You could search this site and read what people have said before, also. )
1. Some say advance the cath 1cm per second.
2. Before you pass the shoulder, patient's chin to chest and turn towards the side of insertion.
3. Power flush (can often undo the loop).
4. Position change for patient ie sitting straight up, arm up by head, arm down by side.
I don't know what kind of technology you have, but another thing to think about is taking your statistics to administration and recommending improved technology to help the success of your program.
What are you finding out when you go to IR? They are actually having to exchange? They cannot straighten it with a wire and watching it on Fluoro? If they are finding DVT/stenosis and they can't advance it either, your "solution set" is different than if they are just advancing it with their fancy wires.
If you are just curled in the axillia, or up in the neck, or even looped in the SVC, there are numerous things you can try, depending on your hospital policy.
While you are advancing the catheter, periodically check for blood return. This will give you a heads up in terms of what is going to be shown on your CXR. If we lose our blood return during advancement, we try to problem solve to the best of our ability prior to the CXR. Almost always, (although I have seen it happen) you won't get a return when your cath has looped, folded, coiled, bent.
Coils and loops can be related to anatomic variations, so in a way managing the "roadways" of the vessels helps to give the catheter and wider road with less side streets. To that end, the various tips for advancement help decrease the chance of looping, etc. Also, getting a good hx prior to starting may help make decision about which side to put the picc in and what techniques to utilize for success.
Here are a couple tips. (You could search this site and read what people have said before, also. )
1. Some say advance the cath 1cm per second.
2. Before you pass the shoulder, patient's chin to chest and turn towards the side of insertion.
3. Power flush (can often undo the loop).
4. Position change for patient ie sitting straight up, arm up by head, arm down by side.
I don't know what kind of technology you have, but another thing to think about is taking your statistics to administration and recommending improved technology to help the success of your program.
Good luck, I know it can be frustrating.
Kathleen
Kathleen Wilson, CRNI