Recently one of our nurses placed a PICC in a woman weighing 611 lbs. Portable chest x-ray could not penetrate through the layers of adipose tissue to see any of the PICC. The picture looked like a "white-out". After a repeat x-ray the view was unchanged. The nurse consulted with the primary stating that she could clearly see the PICC going down using Sherlock tip locating system and she had an excellent blood return. Patient displayed no cardiac arrhythmias. The primary physician consulted IR who state they didn't have any other options to visualize the PICC due to the woman's weight. The primary physician gave an order to use the PICC.
I had suggested that the stylet could have been left in place during x-ray and was told that given the poor quality of the film that even that wouldn't have been seen.
My question is, what are others doing when placing PICCs in patients that are too large for any diagnostic table (CT/fluoro)?
This was our first experience with a patient this size but I'm sure not the last.