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PICC migration and need for replacement

I am interested to know what everyone is doing or should be doing when a PICC slowly migrates out during dressing changes etc.   We do a new CXR when a patient is admitted to the hospital with an existing PICC line.  On occasion we find that the line has migrated out several centimeters and no longer in the lower SVC/CAJ.  Sometime, it's even migrated to  the junction of the brachiolcephalic and SVC.  Currently, we let the provider know the location to make a determination in regards to length and type of treatment needed.  We encourage replacement in any Chemotherapy or TPN administration.  My question is are there any quidelines that speak to this?

Catheter dislodgment is a

Catheter dislodgment is a problem you can prevent by using a good securement device(s). The tip location should always be low SVC/RA junction, period. SVC in adults in ~7 cm. If original tip was at CAJ, once it pulls out by 3-4 cm it is no longer acceptable for infusion and something must be done. You should assess the therapy and its characteristics and the remaining duratio of therapy. Is a CVAD still needed or can you finish with some type of PIVC? If you need a CVAD, it must be exchanged over a wire or removeed and a new one inserted. This is based on your assessment and you would need to correct it. It cannot remain in a suboptimal position without risking vein thrombosis, vessel erosion and subsequent extravasation. Tips higher in SVC are more likely to migrate to IJ and other veins. See INS SOP on CVAD Malposition. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

I own a vascular access

I own a vascular access company, oh so many SNF's etc. continue to use PICC's with PICC continually migrating out and do nothing. That is why we try hard to do routine dressing changes on these devices because the nurses in the SNF's are largely unfamiliar and inexperience with any devices, even PIVC's. That way we can make sure the PICC is maintained and correct it so it does not have to get replaced.  The nurses pull it out accidentally with dressing changes, and my favorite, the CNA's tell the patient the PICC does not have to wrapped for a shower! Anyway, I replace them if they migrate out, I have absoluetly no idea where the tip is to begin with because no one sends any documentation or passes anything to the SNF about int/ext measurements.  The SNF nurses do not even know what a internal/external measurement is, they have no idea that devices are measured in cm.  I replace them due to risk of continued migration when dsg change is done, nurses using it unsafely when that happens and cost.  Sorry for the rant. There are some really great nurses that work in rehab, the state that I ran my business in, had SNF nurses with absoluetly no knowledge.  Denise

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