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md1
Leaving wires in PICC's

It is my understanding that guidewires in PICC lines should be removed once the line is placed and the sterile field in removed. Can guidewires are be left in place for several hours  for the purpose of seeing the catheter more easily on chest x-ray and for future manipulation of the line? I am concerned that this is not safe practice and on removal some wires have had blood clot residue.

lynncrni
 I can speak from personal

 I can speak from personal experience on this practice. Many years ago, when PICCs first began back in late 1970's, early 1980's, we routinely left the wire inside our PICCs. Then we immediately took the patient for a stat xray or called for a stat portable xray. And removed the wire after it was confirmed to be in proper position. This length of time was always less than 30 minutes and most of the time was a lot less than that.  We took great care to carefully encase the external portion of the catheter and wire inside sterile gauze, then wrapped the whole arm with sterile roller bandage and monitored patient activity closely, not allowing any arm bending. Now with technology advances, this practice is not necessary. You can rule out a jugular placement with the US probe.  Search this site for more discussion of that procedure. ECG is even better for confirming tip location.

Wires should never be allowed to reside in a PICC for an extended period of time. These wires are usually not true guidewires. They are stylet wires. They may or may not have a floppy tip. If the tip is stiff along with the entire wire, patient activity can damage the PICC. Also, leaving these wires in place would not be following the manufacturers instructions for use. A guidewire in one that is safe enough in its design to be advanced into the vein alone. A stylet wire does not have the same safety features. But there is not any wire designed to be left inside the PICC for any extended period of time. Any portion of the external catheter in contact with the skin for any length of time can never be advanced into the vein. So this will not solve your problem if the catheter needs to be repositioned. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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