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I would like to correct one apparent misconception about the so-called "FDA approval" for saline only flushes. There is no data - clinical or otherwise - that is submitted for review by the FDA to make a saline-only flushing instruction. There is a letter submitted to the FDA from the manufacturer stating the intention of the manufacturer - called a letter to the file. The FDA clears this for use in the market. This decision is not based on outcomes from any study as the term "FDA approval" would imply. So the bottom line is that each facility must do their own data collection and determine if the clinical outcomes with each product are acceptable. Lynn

the whipping syndrome is caused by the power injection.  When the force of the contrast is injected, it causes the picc to "whip back"  sometimes it returns to the SVC location, but we have seen it whip back into the subclavian, IJ and brachiocephalic - therefore leaving your picc malpositioned and at higher incidence of problems such as thrombosis.  The major problem is that when this occur, it may not be found for days.  The CT does not necessarily look at picc tip placement and unless a CXR is performed immediately following the CT, it won't be found until a repeat CXR is done and sometimes that is days later.  The other problem I found is that when this occurs and a repeat CXR is performed, for some reason we are not notified of the malpositioned picc tip unless we happen upon the XRay ourselves.  We have tried to make it a habit to review XRays several days after these piccs are placed but with the number that are being placed, we can't keep up with all of them.  I am not a big fan of power injectable picc lines, but know that sometimes they are definitely needed.  If a patient has reasonable veins, we will place a PASV and request a peripheral for CT needs.