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BeeDee
Moving upper limb for access CVAD

 I fully understand the moving of the arm, for a PICC in the upper arm and maybe a line using the subclavian..for a  non aspirating line, but what use would it be for a juglar approach. Are nurses just asking for it to be done as its #3 on the list of things to do, or is the SVC connected somehow to the  shoulder that I cant appreciate.

 I would understand  looking left or right to move the line  as a maybe. and the deep breath to increase flow  and knock the end off the SVC wall

Appreciate the experts thoughts on this pondering point

Brenda

lynncrni
I am sorry but I do not

I am sorry but I do not understand your question. Are you asking about repositioning a malposition catheter immediately after chest xray following insertion? Are you asking about moving the arm when the catheter will not produce a blood return? Can you be a little more specific in what you need to know? Thanks, Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

BeeDee
Sorry, I did say non

Sorry, I did say non aspirating line.

 I was trying to work out the mechanical action for a CVAD[port] that had entry via the external  juglar [R] and was not able to be aspirated or withdraw from. And whether moving the arms around would play any part in trying to dislodge the cath tip from the side of a vessel ... if that indeed was the problem, or move the fibrin clot around to allow withdrawal to occur.

Has been insitu for nearly a year so not newly placed, and had constant problems with being able to withdraw prior to infusion.

 I can understand with a PICC via the upper limb,that a bit of movement may be sufficient to dislodge the tip, but cannot see how it could be effective with a neck vein.

 

lynncrni
I think you have some

I think you have some misunderstanding about fibrin. Moving the extremity or any part of the patient's body will not cause fibrin around the catheter to move away from the catheter. Fibrin becomes like a capsule around the catheter with smooth muscle cells causing it to become extremely strong after about 2 weeks of catheter dwell, therefore arm or neck movement will not have any impact on the fibrin for any type of catheter. Are you sure this current implanted port was actually inserted via the External jugular? Most will use the Internal Jugular. EJ is a tortuous vein while IJ is relatively straight. Arm movement producing an alteration in the ability to aspirate blood is usually indicative of pinch-off syndrome but this only happens with subclavian insertion sites. The catheter is pinched between the clavicle and first rib, so arm movement will move those bones away from the catheter. Your inability to withdraw blood from an jugular implanted port could be many reasons including thrombotic (either inside the lumen or inside the vein), drug precipitate, or mechanical problems. If this is an EJ placement I would strongly consider mechanical problems due to the tortuous path of this vein. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

BeeDee
I dont have misconceptions, I

I dont have misconceptions, I just have nurses saying to move the arm around when trying to get withdrawal/aspirating fluid.. and I cant make any sense as to why that action would be considered even worthwhile.. so I was asking the experts was I missing something..

 Glad to know I wasnt!!

 thanks for the reply

lynncrni
This is coming from the idea

This is coming from the idea that moving the arm will relieve the compression of the catheter between the clavicle and first rib for a subclavian insertion site. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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