I placed a PICC in a patient on 05/10/07, it was unremarkable. I cannulated the median cubital vein via micropuncture about 1.5-2" below the ac. The cxr was read by the radiologist as tip in SVC. This pt was subsequently transplanted on 06/19/07 and I was called the following day by the cardiologist to say that they saw the tip of the picc in the aorta. It was also confirmed by ct of the chest on 06/20/07. It was d/c'd and after I spoke with the cardiologist I went to see pt. The nurse said there was no bleeding from the site and the site was not even covered with a dsg. I could actually still see the vein I cannulated. It was such a routine placement, that I did not even recognize the guy. If there was any question about arterial placement I would have pulled the line or at the very least got a blood gas. The only thing I can think of is if at some point I went through the median cubital vein and into the brachiocephalic artey. Any thoughts???
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
Artie Hansford, BSN, CRNI
Interesting. Having canulated an artery in the past (during my initial learning curve with US) and getting a cxr read on it (and with significant bleeding at the site), the tip was not in the svc as you may expect. The radiologist said if it is an arterial placed line, the pathway in the chest is higher or lower than the vein (don't remember which one) but it is obvious to the radiologist that it is arterial vs. venous AND it will not drop into the SVC. I believe your initial placement was in the SVC and something happened during or after the transplant. Your picc was in place and without problems for nearly a month prior to the transplantation. That speaks volumes! What transplant did the patient receive?
Artie Hansford, BSN, CRNI, VA-BC
Yes the left subclavian artery arches above the clavicle. I am referencing Jamie Santolucito and Oregon Health Sciences University wonderful x-ray in the Gallery. It was placed from the left side. Right subclavian artery does not arch as high but will cross over the midline and enter the aorta.