Hello all,
Our team has had a few obese patients recently with loose large upper arm tissue and vessels that were 2 to 2.5 cms deep that we have placed PICCs with initial tip placement confirmed in the SVC. Within 1 to 3 weeks, the PICCs have become occluded and found to have the tip of the PICC found by CXR to be in the subclavian or brachiocephalic veins with the extra catheter in the arm tissue where it has kinked. Has anyone else experienced this situation? Any suggestions on how to prevent movement of the PICC in this situation?
Thank you,
Pam
The SVC in adults is about 7 cm in length. What part of the SVC was the site of the origial tip locationi? It should have been in the lower third at or very near the CAJ. Tip migration can easily happen when the tip is left in the upper half of the SVC. but that usually means the tip is going to the IJ or contralateral subclavian. Sounds like this was caused by muscular action of the arm. Which vein was used - basilic, cephalic, or brachial? The only actions you can take would be correct tip location and adequate securement at the insertion site. Cephalic vein is a superficial vein through the entire arm so there could be more muscle influence on it. But your depth sounds like brachial. So not sure if there is anything you can do to prevent this from happening IF the other 2 locations are good.
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
Thank you for responding Lynn. The PICCs were confirmed in the lower SVC or CAJ with a 3CG waveform and secured at the insertion site as usual with a securement device. All of the vessels were either the brachial or the basilic. The only other common denominator is the arm size and type of tissue. It has been very frustrating to have several of these instances but only in this type of body habitus. I was hoping there was another answer.
Others may have some tricks, but I don't know about them. Sorry
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