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CGC-PICC
over wire picc exchange

If you have a pt that has chronic renal failure and you as a picc nurse have only one arm to utilize. If you have a picc line in place that the physician is wanting replaced due to lack of blood return. Cath-flo has already been used on the line and the line is still not drawing blood. Would you consider and over the wire exchange? Should you try a different site or vessel or what would be the most appropriate choice? the current picc has been in place for 2 weeks.

 

Saharris
Exchange

Assuming you have Nephrology agreement with this PICC, I would first look at X-ray to check if you can add a few centimeters to ensure CA junction placement. I would not use a different vessel in light of renal status, I would exchange, ideally with a PICC that is longer if possible.

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

lynncrni
 How do you add a few cm

 How do you add a few cm without advancing external Cath segment that has been in contact with skin? I think this decision is made on a case by case basis weighing risk & benefits of each option for each pt. 

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

Saharris
Clarification

If possible the added cm's would be on the new catheter with exchange.

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

lynncrni
 OK, now I understand your

 OK, now I understand your point. Just wanted to make sure no one thought you could simply advance the existing catheter. 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

CGC-PICC
I was thinking that if the

I was thinking that if the line was not pulling blood due to precipitate, should a wire even be placed inside for the exchange.  I understand exchanges are being done through the sheath but I dont think our team knows how to do them.

 

Cindy Clinkenbeared RN, VA-BC

Saharris
Precipitate

In my experience lines that have incompatibility precipitates will be totally occluded. No flush or drawback. If the wire won't go through the line on the exchange you have to pull everything and start over anyways. I don't do exchanges using introducer over old line as it seems too "dirty" to me. The guidewire should be measured in relation to the line so if there is obstruction in the line the inserter will know.

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

lynncrni
 I have done many overwire

 I have done many overwire exchanges in years past. I don't think you will always known what the wire is passing through There will always be fibrin/thrombus, biofilm, and possibly drug precipitate inside the lumen. Some precipitate may totally fill the lumen, be very solid , and make it impossible to pass the wire, but I am not certain that will always be the case. Driving a wire through the lumen could easily shed fibrin and biofilm into the blood stream which will end up in the lung circulation, blocking arteriold and capillary circulation. Again, the question is does this pose a smaller risk to the patient than putting in a new catheter. That will always be the basis for al decisions. 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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