I placed a PICC yesterday evening that showed the line coursing down the left side of the chest on xray. I know for a fact it's in a vein because it's below the level of the clavicle and I checked it carefully when inserting...definetly not arterial. Rad states this morning that in looking at a CT of the chest that was done afterward, pt has a persistant left sided SVC and doesn't appear to have an innominate vein? I've never had this situation before and I'd like to know if it's alright to leave the line in place? It's at the atriocaval jx.
Thank you,
Ann
Yes, as long as the tip has not entered the coronary sinus.
Jack LeDonne MD, FACS
Director of Vascular Access
Presidnet, Association for Vascular Access
Greater Baltimore Med Ctr
6701 N. Charles St
Baltimore, Md, 21204
I would suggest a strong word of caution about "knowing" that a catheter tip is not in the artery. The only way to actually know this is by doing blood gases from a sample drawn from the PICC or by transducing the line for pressure. You can never truly know without these diagnostic methods. Looking for the arch over the subclavian is totally correct, but I have been the expert on legal cases where the inserter "knew" the PICC was in the vein by their physical assessment when it actually proved to be in the artery. As you can imagine this can produce some horrible outcomes for the patient including arm amputation. Persistant LSVC is the most common location that can easily be confused with arterial location. I would evaluate what was infused through the PICC between insertion and the chest CT which proved LSVC. And point out that you accepted a huge amount of risk if anything was infused through it. Always better to err on the side of patient safety with the blood gases or pressure transducing. 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
As Lynn states ...alway treat as if it's an art placement until assured by ABG's.