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linezolid and midline?

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


mary ann ferrannini
My literature has the ph of

My literature has the ph of Zyvox at 4.8 with a mOsmo lLL at 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

Thanks for your input. We
Thanks for your input. We spoke to the hospital that placed the line, but they had no memory of the exact situation. They had the measurments and said that the cxr showed it was "barely svc". It was on the left arm and my hunch is that they measured it short and took a reading of left innominate/svc junction as an ok to use. We had filmed the pt. and added 8cm or so but could not thead it so we brought it back to a midline. It makes me wonder about a couple of things though. If nurses were reading thier own films(for preliminary picc placements like some states) , I don't think we would be as agreeable to a reading like that. Also, I always felt all patients admitted with a central line should have a cxr to confirm position. Thanks again for your reasurrence. Peter Fintonis RN CRNI
Two thoughts come to mind in

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

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