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Stephen Harris
Reinsert PICC?

Situation

     Any feedback on following would be appreciated. Pt. has PICC placed in CA junction and subsequently a surgeon unsucessfully attempts to place IVC filter. Followup xray shows PICC in right subcavian(with left basilic access). PICC was originally placed to the hub and remains so despite PICC position. Power flushing to reposition failed which brings up my question. If pt. is draped and arm is prepped with chlorhexidine can catheter be rewired with navion wire and repositioned? I told attending once catheter is pulled out it can not be reinserted and he wondered why not if done under sterile environment? Thanks in advance for your input.

 

Stephen Harris, CRNI

 

 

lynncrni
Are you talking about
Are you talking about inserting the Navion wire through the dislodged catheter and then advancing the new catheter over this Navion wire? If so, this totally depends on the design of the wire. Since this is a wire designed to be loaded into a catheter and then advanced, I have serious doubts about whether its design will allow you to drive a catheter over an in situ wire. I know of physicians that have tried this with other wires and ended up with broken and embolized wires. So you should check with the manufacturer to determine the specific design of this wire - stylet wire or guidewire?? 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

Stephen Harris
Let me clarify. I am talking
Let me clarify. I am talking about partially pulling back an existing PICC over a sterile field,inserting a navion wire,completly cleaning the PICC with chlorhexidine and then reinserting the picc. I know PICCs that have been accidently pulled by patients and exposed to skin should never be reinserted but a physician has asked if a PICC that has been inserted to the hub and has flipped to the subclavian could be readvanced if the above measures have been taken.  
lynncrni
I would not do this because
I would not do this because of serious concern for infection. Cleaning the external portion of the PICC with any antiseptic agent will not render it sterile. 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

Stephen Harris
Thankyou.  I have shared my

Thankyou.  I have shared my concern for infection with this Doc. (and these post's) and he gets it now.  Just wanted some back-up.

 

 Stephen Harris CRNI

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