We got a call from a Home health nurse stating the patient reports hearing a swishing noise when line is flushed . I recomended she not use it and let us take a CXR and perhaps a 'power flush' with Saline would slide is back in position for the long term Vancomycin infusion.
The wife called my coworker who told her to go ahead and use it anyway ( because she felt the wife was stressed) and we will check it tomorrow . Is there a right or wrong to this ? Or is this a gray area of practice? Thank you
I would fear that it is malpositioned and is up the jugular. I too wouldn't use it... and as long as the nurse is familiar with power flushing, and you have a P& P covering you, I'd see if that works.
I agree! Is this sound heard on the same side as the PICC insertion? If so, this is a prime indication of the catheter tip migrating into the IJ. You did not state what medication is being given, but there is published evidence that catheter tips in this position can lead to retrograde infusion into the intracranial venous sinuses and produce neurological problems. Stop the infusion, get an xray which includes the neck area by telling radiology what you suspect. The PICC should not be used until it has been repositioned into the correct location at the cavoatrial junction. Where was the original tip location? This tip migration is more common when the original tip was placed high in the SVC and not at the CAJ. 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