One of pur vascular nurse placed a PICC line the other day and had a good 3cg or ECG reading. The redaing looked perfect. However, we got a call yesterday that CXR done for a different reason was showing that PICC needs to be retracted about 7 cm. We retracted it and had another CXR taken and it showed that it was the tip was at the SVC. What do you think caused this contrasting result between the ECG and CXR? We use the ECG at work to minimize the use of cXR post PICC placement.
Movement of the PICC inward is associated with natural arm movement. More likely than not this is what caused the movement. What position was the arm in during insertion? Extended from the shoulder? Bringing arm to the side caused the tip to move inward.
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
April Joy Santos, RN, MSN, Va-BC
Did you visualize the xray? Many times physicians will ask to have the line pulled back so many cm that the tip will no longer be in the SVC or barely at the top of the SVC. Many providers are unaware that the optimum tip location is at the bottom of the SVC. If I had maximum P wave elevation with no P wave deflection (and the patient was in a SR) I would stand by my tip placement. Communicate to the physician that the line was placed with 3CG and that the tip is in the preferred location of the Cavoatrial junction as CXR are not the gold standard for tip verification.
Jessica Newsom