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Picc in subclavian vein
There are times we place Picc or a Picc is in and pulled out some and the x-ray report comes in Picc in subclvian or somewhere in that area.  The Dr's alot of times will go ahead and tell us to use it as a midline.  I have 2 concerns.  One is I would think this is more risk for thrombosis, also, the nurses will still use it as if it were a Picc line and use whatever meds through it.  This has happened frequently in the ICU which is scarey.  I have spoken with the intensivist regarding my concerns but wondering if anyone has any documentation anywhere.  I have spoken with my nurses and asked them to inform the physicians of the risk before we go ahead and decide to keep it as a midline, it really has crossed the midline area right?  Thanks again.  Susan
read the article in Spring

read the article in Spring 2007 JAVA-"Complications of Vascular Access Device Terminal Tip Placement:  A Case Study and Review of Subsequent Legal Action" by Nancy Moureau and Ann Zonderman.

 You won't be leaving it in the subclavian ever again!

Any catheter that is located
Any catheter that is located distal to the lower portion of the SVC is no longer a central venous catheter. There is what has come to be known as the midclavicular tip location which is in the subclavian-axillary vein. And then there is the midline tip location which is in the basilic or cephalic vein of the upper arm level with the axilla but not crossing the shoulder. You will need to read the INS standard of practice, the AVA tip position paper and a recent article in the last issue of JIN on the issue of midclavicular in addition to the article already mentioned. What you are doing is a dangerous practice that increases the risk of catheter-related vein thrombosis and therefore increases your legal liabililty. You should locate all these resources and work toward changing this practice. Lynn

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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