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PICC coiled
Recently, we placed a PICC that ended up coiled in the subclavian vein.  What is your protocol for repositioning these?  We do not have a Sherlock and we don't do catheter exchanges yet.  We know that you are not supposed to pull the catheter out and re-insert.  Would you do an exchange or place a whole new PICC?
In the old days, before we
In the old days, before we had US and tip location systems, we would leave the stylet wire in place, encase the entire external portion of the catheter in sterile 4X4's and wrap the arm with sterile Kling or Kerlix. Then get a stat chest xray (IV nurse was assessing tip location even then). If it was coiled or malpositioned, we would take down the dressing and withdraw and readvance. Please note - the entire external catheter was not allowed in contact with the skin, the IV nurse went with the patient to xray so we monitored their activity with that arm, and we were assessing the chest xray immediately. This took less than 30 minutes before we knew the location of tip and position of the catheter. Then we would finish the procedure by re-creating a sterile field, removing the wire and flushing and securing the catheter. I would not recommend this without these controls. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Glenda Dennis
Lynn's comment is how I fix
Lynn's comment is how I fix most malpositions as well.  I have learned to look at the IJ in the neck to find a malposition there before I even call for a chest x-ray.  I can usually fix those easily, maintaining my initial sterile field.  Just have to be very careful where I put my US probe after looking at the neck in order not to contaminate my field. 
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