Friends,
placed a PICC this morning (4 Fr Groshong). Tip got placed in deep vena cava sup near entry to right atrium. Radiology dept suggested to pull the catheter 1-2 cm, but I told the physician on the ward that it was really fine where it was.
She the told me that they had had a patient with a Hickman residing with the tip some centimeters down into the atrium and he had developed a "thick layer of bacterial growth" on the catheter surface. This growth, the physician told me, was due to the low tip location where the turbulant blood flow would give a higher risk of infection and thrombosis. Thus she wished to pull the PICC 1-2 cm, and I said OK, then you should probably do that.
- Is it correct that a tip location in the atrium means a higher risk of infection and of thrombosis?
- Is tip placement 1-2 cm above cavoatrial junction better than at the junction?
Thanks
Mats
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
Thanks Lynn,
What is your and everyone elses practice when a PICC gets tip placement
- in the CA junction?
- 1-2 cms into the RA?
What catheters do you pull up and how much?
Mats
Mats,
How are you? Haven't heard from you in awhile. Hope you are doing well.
Just thought I would add that there have been studies that show (and I can't quote them to you, but I do know they were disscussed at the last AVA conference by a vascular radiologist) that the best placement for a dialysis catheter is in the right atrium, and those catheters are huge and usually not well cared for on the outside, so if what your doc said were true, I think we would not see physicians placing these lines in the right atrium. And this does not make sense to me anyway. I always thought that the more blood flow you have, turbulant or not, the better it was for the catheter to NOT develope thrombus. I would ask your doc to provide you with some info on this statement. I do not know about you, but I get tired of looking up stuff to refute these doc's. Let her bring you the studies to show she is correct. I bet she can't.
Have a nice week!
Thanks Heather,
I bet she can't. And my reasoning is just like yours: the more flow and the more turbulance, the risk of thrombus and infection should get lower, if anything. Not greater.
Mats