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nurseirie
Malposition of the day?

Hi all, my new mentors

 

OK. I changed the thread 9/2/2013.

I thought the Azygos vein attached vena cava from the NOT not left.

Look at the other attached pic (azygos1). That is definitely Azygos.

The angle and course is different in the other pic.

Well, I withdrew the groshong 4 cm. Got scared. LOL

 

Malposition of the day. Inserted a right sided Groshong catheter ealier today. I had to leave before looking at the CXR. My PICC colleague texted this PIC to me (I tweeked it a little, still a bad phone photo).

The RAD told the nurse to withdraw the catheter 3,5 cm.

Suggestions/opinions?

Above Carina, right?

Where is the tip? It's like a 90 deg. turn to the left and then.

Why? Double Vena Cava?

I know; there is some other things going on there.

Patient is on bensylpenicillin (abx) and isotonic fluids

Guess I have to fix this tomorrow

Ill try go get a better PIC tomorrow

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Image icon azygos2.JPG101.96 KB
Image icon azygos1.jpg26.22 KB
jhr911
 Looks like azygous to me. 

 Looks like azygous to me. 

lynncrni
 Looks like a weird angle

 Looks like a weird angle with none of the usual landmarks for a chest xray. 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

MarkCVL
Azygos Placement...if the

Azygos Placement...if the presumed landmarks are correct

Timothy Royer B...
I have seen many Azygos

I have seen many Azygos placements in this view.  A Lateral would differently show its true course.

 

Tim Royer

JackDCD
Azygos

It's in the azygos. You can power flush or even leave it and rexray the next day...they will often spontaneously correct themselves

 

Jack

 

nurseirie
Look above...

Look above. I changed the thread

Nurse specialist ICU/ANE/PICC.

Dep. of Neurosurgery

Umea University Hospital/SWEDEN

lynncrni
 I am a little confused. Are

 I am a little confused. Are these from the same patient or 2 different ones? What happened to the original picture you posted? 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

nurseirie
OK...

OK. The firt pic (azygos2) is from the patient above. I withdrew the catheter 4cm (to the white line). Decent position.

The second pic (azygos1) is from another patient a couple of moths ago. I'm assuming Azgos vein in that case(?) 

 

Radiology showed no interest in these malpositions. I guess I have to demand a new evaluation next time. 

 

Nurse specialist ICU/ANE/PICC.

Dep. of Neurosurgery

Umea University Hospital/SWEDEN

Ann Earhart
azygos, posterior, or weird angle SVC?

The view of this x-ray is anterior-posterior.  While the angle from this view looks like a sharp 90 degree turn, a side view (lateral) will give the view what path the catheter is doing.  The catheter may be going sideways-azygos, backwards-posterior, or even maybe inside the SVC going towards the Cavo-atrial junction.   I would recommend to your physician next time a lateral view.  I, personally have seen all three of these with this angle.  Also-this might be the only open vessel for this patient? 

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