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PICC placement in pt with implanted vascular access device

There have been several occasions I have had to place a PICC in a patient who has an implanted vascular access device.  In all these instances either the catheter will not thread completely or when it is I am unable to aspirate blood.  Pulling back 5 - 8 cm results in good blood aspirate but xray reveals the catheter tip to be in the subclavian.  Is optimal placement in the cavoatrial junction typically difficult along with an IVAD?  LutherPICCRN


If you have a relatively

If you have a relatively uncomplicated patient, the placement should not be difficult.  However, the fact that you are placing a PICC in someone with  IVAD may indicated a more complicated patient.  many patients with an IVAD may have had one or more previous IVADs with the possibility of residual scar tissue.  The only way to tell what is going on is to do a flow study which I would highly recommend.  Without a flow study, the docs tend to keep ordering PICCs on these patinets over and over, because no one passes the word along that previous attempts have failed.  Also you have to rule out the possibility of a clot.

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