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kobi888
Picc tip?

Pt. needed PICC for TPN.  Radiologist stated PICC was at the junction of the subclavian and SVC.  Any thoughts on this placement for TPN to be infused?  Pt. was very obese. 

Thanks in advance

lynncrni
The cavoatrial junction is
The cavoatrial junction is the ideal tip location for all PICCs and those infusing parenteral nutrition is no different. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kobi888
I realize this PICC tip is
I realize this PICC tip is short of the ideal location, but is this still considered acceptable for infusion of TPN since it apperars to be at the very beginning of the SVC?
smarison
i wouldn't give TPN thru
i wouldn't give TPN thru that line.  Any pull back of that catheter and you are out of the SVC.  Susan
rivka livni
Did he mean to say
Did he mean to say Brachiocephalic / SVC ? I thought the Subclavia V goes into Brachiocephalic (Inomminate) vein before it enters the SVC. So that if it's Brachiocephalic / SVC it is certainly not ideal and that PICC should have at least another 5cm added to it, but it should be OK to use until you arrange for exchange of a longer catheter.
lynncrni
You are right! I did not
You are right! I did not read this carefully enough. There is no junction between the subclavian and the SVC because the brachiocephalic is in between. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Mari Cordes, BS RN  Nurse
Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care
 
"Venous thrombosis is a potential postplacement complication of a central venous access device (VAD). Improper catheter tip position is a predisposing factor, especially when the device is used to administer parenteral nutrition (PN)."  
 
Journal of Parenteral and Enteral Nutrition, Vol. 31, No. 5 2007 382-287 DeChicco et. al.

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

afruitloop
Also keep in mind that
Also keep in mind that PICC's high in the SVC, especially from the left have a high incidence of problems.  The left brachiocepahlic / SVC junction is a very poor placement.  THe angle of the PICC coming in this area positions the PICC at a location of "jabbing" the right side of the upper SVC/ junction area.  There was an incidence of errosion of the upper SVC by the catheter, dumping TPN into the thoracic cavity.  High PICC's are bad, left sided high PICC's are very bad!  LOL

Cheryl Kelley RN BSN, VA-BC

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