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reposition vs wire exchange

I was challenged today regarding a decision to exchange a picc that was malpoitioned on the first CXR.  I would do a wire exchange of this line if I didnt think I could flush it down to the correct position.  My colleague would prefer to pull the line back and readvance it to attempt to fix the malposition after making a sterile field again.  What is the correct thing to do?  We use to do one reposition under "sterile field" but I remember learning this may not be the best thing for the patient. 

 After the external portion

 After the external portion of the catheter has been exposed to skin, the idea of pulling back and repositioning by readvancing into the vein is not possible. The external portion can never be made sterile again. So you would have a contaminated procedure. Your only options are power flushing to attempt repositioning and if that does not work, then you would need to do an exchange overwire or a new insertion. If it were me, I would prefer a new insertion. The same issue of contamination exists with the exchange procedure. 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

Least Invasive First

In many cases having the patient sit up sat much as possible then pulling the device out 1 or 2 cm then flushing WILL get the tip to drop.  I have had great success with this (this is not an issue anymore with tip confirmation technology) I also always try the least invasive intervention first, if this fails then an over the wire exchange. Once the dressing is in place I would never pull back and re-advance it’s not recommended due to risk of infection.

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