I wasn't a true believer in power flushing. Many of the PICCs that I have placed in the past up the jugular never repositioned into the Lower SVC. However a malposition into the azygos vein was corrected. PICC spontaneously malpositioned a few days after placement.
Those downloading for presentations will need to get permission to use (I will usually give permission for educational purposes). None of these x-rays may be published.
Tim
Robbin George RN VA-BC
The tip is 2-3cm above the caval atrial junction. I would really like to see this 2cm deeper, but am satisfied with the lower SVC. If the PICC tip was at the caval atrial junction, in theory, it would be less likely to malposition.
Could you describe your technique for power flushing? How much volume did you use? Was this a silicone or poly PICC?
Thanks
It was a Polyurtherane power injectable PICC (PowerPICC - dual lumen 5fr). 10ml both lumen at the same time. Did it twice before re-xaying.
Great pics Tim.
One thing I would like to point out is that our radiolgists often read the Azygos placement incorrectly. Even my most trusted rads will say that it is just curled up the svc or going back up the other brachiocephalic vein. I just go with my gut and do what I think is appropriate.
It is amazing how much longer the catheter appears after it has dropped into the SVC. That is another clue, if you are expecting a much deeper reading and the tip looks funny definitely suspect Azygos.
I've had great results with the power flush myself.
Had one over the weekend that did not drop on the first attempt at the bedside. Rad offered to do it under fluoro which I got to see live. It did take him two tries. There was a preexisting dialysis line that was getting in the way.
Darilyn
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
we use power flushing to correct any malpositioned picc tip. we have been successfull nearly 100% of the time when a malposition occurrs. Although they are very infrequent, some of the repositions we have been successful on are the contralateral placements, IJ, azygous, and even some coiled in the brachiocephalic. when we power flush, we sit the patient up as straight as possible (if allowed), remove the caps and flush. We leave the patient sitting up until a repeat CXR has been done. I have heard of some nurses flushing through both lumens at the same time, but we usually do not do that here.