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Redhead RN
PICC Accidental Pullback

Hi all,

If there is an accidental pull back of a PICC catheter when do you obtain a CXR to assess PICC tip location?  Our current policy says if there is a 3 cm pull back than a CXR is required. With the use of ECG technology the tip should be in the lower SVC or CAJ would this give more leeway?  Thanks, Ruth 

The method used to confirm

The method used to confirm the original tip location does not have any effect on the answer to a partially dislodged PICC. The answer is a matter of anatomy. In the average adult, the SVC is about 7 cm in length. If the original tip location is at the CAJ, your policy of 3 cm is a reasonable approach to this question. From the CAJ, accidental dislodgement of 3 cm would mean the tip is in the middle of the SVC. Anything greater than that would put the tip higher in the SVC and with that comes greater risk of tip migration to another vein, and the tip abutting the right side of the vein when it has been inserted from the left arm. This abutment increases risk of thrombosis and complete vessel erosion through the vein wall. So the need for a repeat chest xray depends on where the original tip was located, the amount of dislodgement and your judgement about where the tip is now. Anything higher than mid SVC needs xray. Also, your staff must know the signs and symptoms of tip migration so an xray can be obtained at any point when tip migration is suspects. This is true for all CVADs and not just those that are disldoged. 

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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