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Kelly Smith
power piccs
We are considering using power piccs but need to do some information gathering first.  Would anyone who uses a ct injectable picc in their facility please email me privately re: criteria for placment of ct injectable picc versus regular picc, heparin versus saline flush on ct injectable piccs, and your opinions of differences between brands of ct injectable piccs, and percentages of ct injectable piccs versus regular piccs.  My email address is [email protected] .  thanks in advance.
I would like to correct one
I would like to correct one apparent misconception about the so-called "FDA approval" for saline only flushes. There is no data - clinical or otherwise - that is submitted for review by the FDA to make a saline-only flushing instruction. There is a letter submitted to the FDA from the manufacturer stating the intention of the manufacturer - called a letter to the file. The FDA clears this for use in the market. This decision is not based on outcomes from any study as the term "FDA approval" would imply. So the bottom line is that each facility must do their own data collection and determine if the clinical outcomes with each product are acceptable. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Karen Day
Karen Day's picture
we use both PASV and power

we use both PASV and power injectable picc lines in our facility.  It is our understanding that due to the firmness of the power injectable vs the PASV picc, they can cause a higher incidence of thrombosis in the patient.  we currently only place power injectable picc lines in patients that have a definite need for them.  We have also seen some of the "whipping syndrome" that power injectable piccs can cause.


Alma Kooistra
What does whipping syndrome
What does whipping syndrome look like?
Alma K
Karen can you let us know

Karen can you let us know more about this whipping syndrome? Our Arrow rep has mentioned this about the Bard power PICC during power injection and did a slight demonstration but I would like to know more from a fellow clinician. 




Karen Day
Karen Day's picture
the whipping syndrome is
the whipping syndrome is caused by the power injection.  When the force of the contrast is injected, it causes the picc to "whip back"  sometimes it returns to the SVC location, but we have seen it whip back into the subclavian, IJ and brachiocephalic - therefore leaving your picc malpositioned and at higher incidence of problems such as thrombosis.  The major problem is that when this occur, it may not be found for days.  The CT does not necessarily look at picc tip placement and unless a CXR is performed immediately following the CT, it won't be found until a repeat CXR is done and sometimes that is days later.  The other problem I found is that when this occurs and a repeat CXR is performed, for some reason we are not notified of the malpositioned picc tip unless we happen upon the XRay ourselves.  We have tried to make it a habit to review XRays several days after these piccs are placed but with the number that are being placed, we can't keep up with all of them.  I am not a big fan of power injectable picc lines, but know that sometimes they are definitely needed.  If a patient has reasonable veins, we will place a PASV and request a peripheral for CT needs.
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