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"Picc lines do NOT need to be Centrally placed for Abx. Therapy"

I was wondering if there is any evidence based information supporting Picc lines NOT being Centrally placed for IV antibiotic therapy. I was told by a Pediatric Physician today that Picc lines do NOT need to be central (SVC, Cavoatrial Jxn) to support IV abx. therapy. The pt. had a RUE Picc line placed and same day CXR verified Picc tip was in the Lt. brachiocephalic vein. The line was repositioned and no follow up CXR done. I was told by the patients bedside nurse and physician that no follow up CXR was necessary and that Picc lines did not need to be centrally placed for IV abx. therapy, only for TPN.  My question then is why place a Picc line? Is this what is being practiced?

 Absolutely not what is best

 Absolutely not what is best practice! We fought this battle during the 1990's. Any tip location outside of the CAJ is a suboptimal location and has much greater risk of complications such as thrombosis, tip malposition, etc. This is true regardless of what infusion therapy is being given. Suboptimal tip location at one time were known as midclavicular tip locations. INS had a position paper addressing the fact that tip locations in the mid-axillary vein, subclavian, brachiocephalic veins all fell into this high risk category and this tip location never has been recognized in the INS standards of practice. AVA published a position paper on this same issue several years ago and it can probably be found on this site, although I am not sure where it is filed. Also see the 2011 INS standards on Catheter Malposition. You will need to do some urgent education for this physician and nursing staff. Correct CAJ tip location is the goal for all PICCs. As stated in the old AVA paper, the only time it might be acceptable to allow a tip to remain in a suboptimal location is when anatomical and pathophysiological changes prevent advancement to the CAJ. When this is the case, there must be a more indepth assessment of patient factors, therapy factors, etc. to determine if this suboptimal location or another type of catheter insertion would present the least risk for the patient. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you Lynn. I fully

Thank you Lynn. I fully agree! It is an ongoing struggle with some of our physicians but I feel I have to be vigilant for our patient's safety sake. Thanks again for your reassurance!!

manufacturer instructions

refer to catheter manufacturer for instructions for use

You wil find tip termination states cavo-atrial junction or lower one-third of SVC or SVC

antibiotics are listed as an indicaiton

No where in the instructions does it say midclavicular which is outdated and disappeared in 2000


Thank you Kathy!!

Thank you Kathy!!

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