Picc was placed in a patient from the left side and 3cg tech was used to verify tip location. With this particular insertion, the navigation system, Sherlock, showed the picc dropping approx. mid subclavian region and changes in the p waves were noted. So per guidelines, the picc tip was in the lower third of the svc verified by obtaining max p waves. With a routine am cxr, the primary Rn called our picc team to inform them that the radilogist commented about a possible left side svc and the picc tip was visualized in the distal left svc. Our question is, is it considered a malpositioned picc if the patient has a double left sided svc and is it safe to leave the picc if the tip is in the left sided svc?
It is acceptable to leave a CVAD tip in a persistent left SVC, however you must have some diagnostic tests on the blood flow pathway back to the right atrium. This should be done in radiology to show that this pathway can tolerate the presence of the catheer and the fluid flow.
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
hello Sueherran
is it considered a malpositioned picc if the patient has a double left sided svc and is it safe to leave the picc if the tip is in the left sided svc?
If the tip is in the right or left SVC, it is ok to use. We had a case with double SVC, and the patient came for the picc twice in her treatment. One time we kept the tip at the left and one time at the right. in those cases, the chest x-ray is used with recent CT to confirm the tip. as technologists, we rely on navigation only, not on ECG reading.
Ibraheem Aljediea
Johns Hopkins aramco Healthcare
Saudi Arabia
For patients with persistent left SVC, they may have a single SVC on the left or may have an SVC on the right or the left. When the catheter is shown on the left side of the medeastinum, it could be confused with an arterial placement in the aorta. So first you will need evidence that this is a venous placement through transducing the vessel pressure or measuring blood gases drawn from the catheter. Once you have confirmed that this is indeed a left SVC, the next step is to confirm the venous pathway back to the right atrium. If you have confirmation that the blood flows from the left SVC in a safe pathway to the right atrium, it is acceptable to use it for infusion. Once this confirmation is done, this information should follow the patient until this catheter is removed so that these tests are not repeated unnecessarily.
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