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Tricky CXR

Here's one for those who like interesting PICC xrays. Pt was 2 days P/O after an aortic aneurysm repair. Radiologist's call was "line curls in the SVC--you need to pull back 15cm to straighten it out and get another film". I wanted to advance 3cm and call it good but he wouldn't budge. See 'loopy1' xray.

Here's what happened. The PICC tip terminates right at the level of the tele lead. The loopy line is a mediastinal drain whose tip is at the same level,just 2 or 3mm away on the film. You really have to look close but once you figure out which line is which it makes sense.  We moved the wires,tilted the pt about 5 degrees left and re-shot. See loopy2.






Timothy Royer B...
Great x-rays.
Great x-rays.
Glad you liked them,Tim. As

Glad you liked them,Tim. As for publishing...maybe some day.

Here's another one. In case there is any doubt about where this one went,the title should be a big clue. (Not my placement,BTW!!)

A couple of our nurses still
A couple of our nurses still don't believe that they should be doing chest film interpretation for PICC tip placement (even though we've intervened and saved a few optimal placements from being changed)  -  this will help.  Thanks, David!


Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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