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dtarvin
power injection of PICC not in SVC
Does anyone have policy or evidence based practices on whether it's OK to power inject a PICC that is not in the SVC. Perhaps one unable to be passed. beyond the subclavian. At our facility Radiologist says "No power injection" but are now asking .....if the pt had a A/C IV it would be power injected and we may not know that there may be stenosis, etc. of more central vessels.
amaguila2009
Theoretically, we can use a

Theoretically, we can use a catheter that is in the subclavian or beyond for power injection. But in practice, the dwell of the catheter is where the issue really starts. Before you power inject, it is a must that the CT techs check for brisk blood return. If this is not experienced (which would be common if not close to 100% when your line is short of the SVC a few days after insertion), that line should not be used for power injection at all. So, if a line has just been placed that is short of the SVC, then you probably can do power injection through it.

Chris Cavanaugh
It is NOT SAFE to power

It is NOT SAFE to power inject with a PICC or CVC not in the SVC, per manufacturer's guidelines for PICCs and CVCs (would be considered off label use) as well as ASRT (American Society of Radiology Technologists)guidelines.

Peripherial IVs, 20G or larger, can safely be used to power inject if they are patent, give a blood return because they are short, less than 2 inches long.  These cannot move once they are placed.  They may back out of the vein a few mm, or move a few mm from side to side, but even that is rare, because of the stiffness and short length of an IV catheter.

PICC lines and Central lines are another animal entirely.  With a PICC, the size of the catheter, the flexibilty of the catheter and the length predispose it to complications when power injected.  PICCs will move.  Back and forth against the vein wall , whip around, move out of the vein they are in and back on themselves or into another vien.  A PICC not deep enough in the SVC can flip back into the jugular, inomminant, subclavian or azygos veins.  If the PICC is deep enough in the SVC, it may back up a bit, and whip back and forth, but generally the flow and the power of the surrounding blood flow keep it pretty straight.  A PICC in the Subclavian or axillary veins will whip, may fold back on itself, travel to a tributary vein. The flow is so much slower in these areas that it will not help to keep the PICC in the center of the vein, so there will be some vein damage from the movement of the catheter.  There is a much higher risk of extravasation in these areas due to the damage from this movement.

With CVCs they are shorter and stiffer than PICCs, but could still cause complications if SVC placement is not confirmed prior to injection.  An extravasation of contrast into the neck of a patient could have deadly consequences. 

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

afruitloop
To add to what Chris said. 

To add to what Chris said.  I have included the link to the ACR (American College of Radiology) guidelines on the injection of contrast.  Verification of the tip must be made prior to injection.  Also, something that surprized me was the statement about obtaining a blood return.  It says something along the lines of if you can't obtain blood, as long a it flushes without resistence, it is OK to inject.

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx

Cheryl Kelley RN BSN, VA-BC

Dawn1
Is a midline catheter safe
Is a midline catheter safe for power injection?
needles
According to a Bard rep I
According to a Bard rep I spoke with, it is not approved for power injection. I am  referring to a Power PICC catheter that is midline.
Chris Cavanaugh
There are no MIDLINE

There are no MIDLINE cathters that are approved by the FDA or indicated by the manufacturer for Power/Pressure injection of contrast.

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

picween
What are your thoughts about

What are your thoughts about CVC'S inserted by surgeons and left in the jugular vein with an order to use?

lme PICC Team Clinical Leader

Is anyone having trouble with the Microclave?

lynncrni
Always, always just say NO!!

Always, always just say NO!! This is a series issue although many physicians do not understand the risk. You must be a patient advocate and refuse to use these catheters until they are properly positioned. The patient may complain of hearing a running stream or gurgling sound, which may be a benign problem, but medications introduced through this catheter can lead to neurological problems. This is because of retrograde flow into the intracranial venous sinuses. Also the risk of venous thrombosis is much greater because of the malpositioned tip. So never use these catheters until they are repositioned!!

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Chris Cavanaugh
Is the order to use for

Is the order to use for Power/Pressure injection of contrast?  If so, then this MD needs some education, as he is setting up patients for complications.

There is a Power/Pressure injectable CVC available but the tip must be in the SVC, and confirmed via visualization (xray, floro, scout CT)

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Candee Eisenhar...
The reason AC or higher is,
The reason AC or higher is, the bigger the vessel the more diluted the contrast.  Remind them that with a PIV you can see if there is an extravasation immediately and can tx; whereas, with a SC you can't see until the problem is much greater!

Candee Eisenhart RN, CRNI, VA-BC

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