Quick question please if you have an opinion. A non-central picc found on admission.(Lt. brachioceph). Tried to exchange. would not advance last 10cm. Left out to midline. 20cm.  Pt has 8 more days of linezolid (zyvox) q12h 600mg. peripheral veins not good at all. Is it acceptable to finish this course of abx. though midline? (now fri afternoon, and we don't do piccs on 3-11 and weekends.) please help....thanks
My literature has the ph of Zyvox at 4.8 with a mOsmo lLL at 290.....so even though it is less then 5 it is close and my literature says it is acceptable. In addition, there is 8 days of the prescribed course of treatment remaining...had there been a longer treatment course remaining I would have re-sited a PICC. Do you know why the line was not placed centrally...if it would not advance originally then perhaps an exchange was not the best way to go ...but of course I was not there so I do not want to second quess you. What was the situation? As you are aware sometimes for anatomic or pathophysiologic reasons a PICC will not thread and all other veins or options are exhausted and you just make the best decision you can and evaluate the risk vs the benefit
Two thoughts come to mind in this interesting situation of a tip not quite central orone that has migraeted out of the SVC:
1- Left sided PICC's with high tips are problematic as the left innominate vein is not a "smooth" course into the SVC. Tips left high in the SVC, especially from the left can irritate, or even poke the right side of the SVC, or even in a couple of legal cases, perforate the SVC. This is critical to remember when placing a pressure rated PICC that will be CT injectd thru, as those tips move around in the vessel, and coudl possibly "pull or flip back" into the opposite innominate vein. This is a great agrument for verifying the location of a PICC tip PRIOR to pressure injection and to always shoot for a distal or junctional tip.
2- Secondly for catheter exchanges, it was always my practice to scan the vessel with the portalbe ultrasound PRIOR to preforming a catheter exchange. There were occasions that I would find an "unhealthy" vein and it would not be suitable for a PICC, (even though one was in it at the present time) It's that old thing again, that we need to think about the health of the vessel before preforming a procedure, especailly if that procedure is a catheter exchange.
Thanks all,
Cheryl Kelley RN BSN, VA-BC