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PICC in artery
I placed a PICC in a patient on 05/10/07, it was unremarkable. I cannulated the median cubital vein via micropuncture about 1.5-2" below the ac. The cxr was read by the radiologist as tip in SVC. This pt was subsequently transplanted on 06/19/07 and I was called the following day by the cardiologist to say that they saw the tip of the picc in the aorta. It was also confirmed by ct of the chest on 06/20/07. It was d/c'd  and after I spoke with the cardiologist I went to see pt. The nurse said there was no bleeding from the site and the site  was not even covered with a dsg. I could actually still see the vein I cannulated. It was such a routine placement, that I did not even recognize the guy. If there was any question about arterial placement I would have pulled the line or at the very least got a blood gas. The only thing I can think of is if at some point I went through the median cubital vein and into the brachiocephalic artey. Any thoughts???
no, I use u/s but the unit
no, I use u/s but the unit was unavailable and the mc vein was so pronounced. we have 4 u/s proficient nurses and only 3 u/s units. I was the odd man out that day.
This is strange but many
This is strange but many arterial placement are hard to recognize. I suppose it could have passed through a patent atrial septal defect from right to left and out the aorta. Or you were in the artery all the way up. Was this ASD present?  Most arterial placements end up in a persistent left SVC. The brachial artery is very close to the basilic vein in the AC fossa, so it is possible to stick it by accident. Did you feel for a pulse before venipuncture. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

no asd that i was aware of.
no asd that i was aware of. chf was only brief hx i got.when i palpsted same area yesterday i could feel a faint pulse, but honestly the pulse did not seem like it came from the vessel i was cannulating, but more like it was in close proximity. maybe i'm just trying to convince myself.
Artie Hansford, BSN,

Artie Hansford, BSN, CRNI

Interesting.  Having canulated an artery in the past (during my initial learning curve with US) and getting a cxr read on it (and with significant bleeding at the site), the tip was not in the svc as you may expect.  The radiologist said if it is an arterial placed line, the pathway in the chest is higher or lower than the vein (don't remember which one) but it is obvious to the radiologist that it is arterial vs. venous AND it will not drop into the SVC.  I believe your initial placement was in the SVC and something happened during or after the transplant.  Your picc was in place and without problems for nearly a month prior to the transplantation.  That speaks volumes!  What transplant did the patient receive?

Artie Hansford, BSN, CRNI, VA-BC

he had a heart transplant. I
he had a heart transplant. I believe the path of the artery arches above the clavicle. I understand that we all make mistakes and I know that I am human, it's just that looking back I don't recall anything that would lead me to have questioned whether it was venous or arterial. Now I am feeling that I will not place a picc if I don't have an u/s available and maybe using a thumbdrive to record the image when i cannulate. every one is content here and I think I may be the only one still thinking about it. 
Timothy Royer B...
Yes the left subclavian

Yes the left subclavian artery arches above the clavicle.  I am referencing Jamie Santolucito and Oregon Health Sciences University wonderful x-ray in the Gallery.  It was placed from the left side.  Right subclavian artery does not arch as high but will cross over the midline and enter the aorta.

If I can get this to work
If I can get this to work right,the accompanying CXR will show an arterial PICC from the right. Does not go way above clavicle,barely crosses midline and looked SVC until the dialysis catheter went in---the tips of the two lines are too far apart to be in the same vessel. WIll also try to attach the fluoro shot after it was adjusted.
wow the xray looks like
wow the xray looks like normal venous placement. on the day mine was d/c'd the line definitely arches higher than on this film and crosses midline. nice shots!!
Timothy Royer B...
Nice x-rays.
Nice x-rays.
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