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malpostioned PICCs

After PICCs are placed, occasionally they are malpositioned up into the jugular from coughing, etc.  Often, if this isn't caught on a repeat xray, the patient catches it when it is flushed because they hear it.  Does anyone ever worry that the tip would become malpositioned into the azygous after it has been verified in proper placement?  And what would be the consequences of an azygous malposition not getting caught?  What symptons would the patient exhibit?

Yes, I have seen patients

Yes, I have seen patients complain of pain between the shoulder blades. This can happen in paitents with severe dehydration and a catheter that was not placed in the lower portion of the SVC. The azygous joins the posterior side of the SVC at the level of the 2nd intercostal space. The catheter tip should be at the level of the 3rd intercostal space, however these are difficult to actually see on xray for all patients. It is better to use the right  tracheobronchial angle + 5 cm to get very close to the  junction of the SVC and right atrium. With mid-SVC placement, you could have a malposition into the azygous vein. Lynn


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

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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