Hi all,
placed a 4Fr silicone PICC today that ended up in upper vena cava 7 cm from ca junction. It is for a breast cancer patient receiving FEC treatment for another 3 months. What is evidence and views on leaving it this way or putting in a new PICC?
Mats
There is a lot of evidence, Mats, that an upper third of the SVC location dramatically increases rates of venous thrombosis. There is a Luciani study, Cadman study, and a whole host of others. Email me privately and I'll send you my article published in Winter JAVA: Challenges in the Accurate Identification of the Ideal Catheter Tip Location. I did a lit review of articles that show a high rate of thrombosis, up to 60% or higher when the catheter tip is in the upper SVC. Even mid-SVC, there is twice the rate of thrombosis compared with the distal or lower third of the SVC. Most of the organizations with position statements on tip location say lower third of the SVC, with some exceptions (dialysis CVCs, for example). I would exchange it and make sure it is very close or at the CAJ. There is a lot of turbulence with inflow of blood coming from both brachiocephalic veins, and with respirations in this location.
Nadine Nakazawa, RN, BS, VA-BC
great to hear from you. We do aim for lower svc/caj, but without other guidance than measurement and Lum, this can happen I think. We have JAVA in the library so I will get the article. Is it possible to do an exchange of a groshong short of doing a totally new procedure? Could a new outer part of an introducer be passed over the catheter into the vein allowing for a new catheter to be placed when the old one is withdrawn. Never heard of anyone doing that, but could it be done? Would it just damage the vein? Or would it just not work?
Mats
Nadine is totally correct. In addition to the thrombus problem, there is also the greater risk of secondary catheter malposition, AKA tip migration when it is left high in the SVC. 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
Depending on the age of the catheter, it is possible to over-introduce a groshong catheter. Minimizing trauma to the insertion site by use of lodocaine and a new dermatotomy is an important aspect of overintroducing. Send me your email address and I will send a description of the procedure.
Daniel Juckette RN, CCRN, VA-BC
please send me the description. I would very much appreciate it.
My e mail address is: [email protected]
Thanks
Mats