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Jenn M.
Suboptimal PICC tip location in peds
Am wondering if anyone is placing PICCs in peds patients with tip terminating in brachialcephalic vein?  I have MDs requesting this for cardiac patients.  Is this against nursing standards for PICC placement (am worried about my license if bad outcome, i.e. thrombus)?
Angela Lee
We occasionally have

We occasionally have requests for PICCs in cardiac patients and ,depending on the defect, I will deliberately place them high in the SVC.   I am not aware of any standard for PICC placement specifically in pediatric cardiac patients.  I think you have to consider each patient individually.  Congenital cardiac issues (we do not have a cardiac unit although I think it's coming) are not my strong point and I will usually confer with the cardiologists and get their advice on PICC tip position.  They will sometimes recommend a  high placement and then any concern about migration into the RA is reduced.  I also look at the intended therapy and consider that in regard to tip placement as well.

I don't have a problem leaving the tip high in these kids.  My thinking is that's better than having a tip compromise their cardiac status in some way. 

lynncrni
The INS standards of

The INS standards of practice were reviewed by pediatric experts, so they standard applies to peds tip locations as well as adults. I would be extremely careful with tips located high in the SVC as they will have a greater chance of tip migration into the jugular or contralateral subclavian. What are the possible clinical outcomes in cardiac patients when the tip is properly located at the SVC/RA junction? Inside the RA can be associated with arrhythmias and tamponade but I am curious to know what negative outcomes are reported or anticipated with the tip in the low SVC. 

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

www.hadawayassociates.com

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

Angela Lee
I just saw an infant with

I just saw an infant with the following cardiac problems:  Double-outlet right ventricle, transposed great arteries, hypoplastic right ventricle and tricuspid valve, pulmonary stenosis and ventricular septal defect.  

He had a Bidirectional Glenn procedure done which included anastamosis of his SVC with his pulmonary artery.  There is no SVC/RA junction.  It is not advisable to go further than the brachialcephalic vein.  We just PICCed him and left the tip high. 

For that reason, if I'm not sure, I always consult with the cardiologist.

lynncrni
Sounds like you are seeing

Sounds like you are seeing very complicated babies that most of us will never have to deal with. You are wise to consult with the cardiologist in such cases. But I would push for SVC/RA junction in most less complex cases. 

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

www.hadawayassociates.com

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

fizerjk
We typically place saphenous

We typically place saphenous or femoral PICC's is children with certain cardiac anomialies that have ungone procedures such as glens or norwoods. Often these children don't have an intact SVC but modified.

 

Jeffery Fizer RN, BSN

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