I needed feedback from the group on using a PICC if the distal tip is in
the SVC but it has a loose loop in the line. The line flushes and has a
good blood return. It is a single lumen 4 french Bard Poly Per-Q-
Cath.
Thank you for your advice.
Janis Strickland
If you found this on xray during the insertion procedure and the external portion of the catheter had been encased in sterile 4X4s to maintain its sterility, you can try withdrawal and readvancement to see if this loop can be removed. If the external catheter has not been maintained sterile withdrawal and readvancement can not be done. You would need to refer the patient to radiology where they may try several techniques to straighted it out. Although it is in the recommended position, loops can become knots preventing infusion and aspiration and making it difficult to remove. So I would want it to be straightened if it were me. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Janis Strickland RN, BSN, CRNI
Education Consultant
SMGSI, Mt. Vernon Campus
605 North 12th Street
Mt. Vernon, IL 62864
Phone: 618-241-2050
Beeper: 618-325-4348
Fax: 618-241-3835
Janis Strickland RN, BSN, CRNI
Education Consultant
SMGSI, Mt. Vernon Campus
605 North 12th Street
Mt. Vernon, IL 62864
Phone: 618-241-2050
Beeper: 618-325-4348
Fax: 618-241-3835
I too have had a loop in the midclavical area..... I remember as I discussed the issue with the radiologist, we discovered in rare situations where the loop and loop again on itself to make a knot.... good luck doing that twice!.. LOL!
A simple loop in itself cannot knot unless the tip somehow comes back up through the loop.
But inserting a wire should straighten out the knot without risk of repositioning up the neck or some other peripheral area.
Why did it loop?.. would be a good question.. .if its because the tip is "jammed" into a fleshy area, then most likely you will soon have pull problems anyway... simply pulling back would not remove that loop unless you pulled back far enough to take the tip off the surface it was pressing against so as reinsertion would hopefully cause it to go another place.
But I've only seen this with the soft groshongs.
As you may know... every heartbeat, cough, or even breathing and raising the arms "all" move the tip and reposition the catheter.
you can take two xrays 30 seconds apart and often see the picc in different locations with each picture with the soft groshongs and no wire in place.
So one approach you could take is to simply re-xray and see if the loop is even still there?... maybe have the patient cough a couple of times and administer an aggressive flush before the next xray... if that doesn't work.. I would then revert to the wire to straighten out the loop and/or repositioning.
But before you do anything.. consult with your radiologist as it may not be a loop at all, but rather when you are looking at an xray from a 2 dimensional angle, a vein that swings back and around can "look" like a loop from the front 2 dimensional view... only another xray from another angle will rule that out.
The second mouse gets the cheese!