I am wondering, in response to a recent occurance, if anyone has established additional "checks" to their PICC placement procedure to confirm venous vs arterial placement. I am aware that an ABG can be drawn or the CVP can be checked if a problem is suspected but do you do anything routinely to confirm venous placement? The radiologist reading on this particular PICC was venous. Thanks, Kathy
One sign on the chest xray is a catheter arching high over the clavicle then passing down into thorax. Any question about this sign, tip location on the left side of the chest possibly thought to be a persistent left SVC, any unusual or strange resistance as the catheter passes through the vessel, any stange feel during flushing, strange appearance or color to the blood aspirated, should always be considered for each PICC. Any of these is enough to warrant an ABG or transducing the catheter. It is always better to error on the side of safety. I have been the expert in 2 cases of arterial PICC placement. One was a newborn where the infant lost the arm and one in an older adult that produce cerebral air embolism with a CVA and neurological limitations. In one case, there was even a large dialysis catheter that should have been a clue when the PICC was seen going toward the left side of the mediastinum. This one also clearly showed the catheter arching over the clavicle as well. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Assuming you use US guidance, do you routinely "see" the needle bevel in the middle of the vein at the time of access? If you are uncertain, and you don't have the usual signs of pulsating, bright red blood, after catheter or even guidewire placement, use your US probe and scan the brachial to be sure you see the wire or catheter in the vein and not in the artery. It's a little trick you can use especially when it's a "messy" US picture and it's difficult to "see" the vein clearly. Dr. Mark Hunter, one of the "fathers" of interventional radiology says "Do not do US Guessing! You must do US Guidance!" I still remember that lecture. It can be a tough job, and one arterial PICC placement can really unnerve you. As the Vascular Positioning System by Vasonova gains wider acceptance and use, it's Doppler sensor at the tip of the stylet will ALWAYS detect that blood flow it going in the wrong direction and you would remove the catheter immediately.
Nadine Nakazawa, RN, BS, VA-BC
i have looked at the gallery, but really didn't come across any good pictures of an arterially placed PICC line, hopefully because they are not left in place, but was wondering if anyone has any good pictures to post.
If you Google 'PICC Artery' at the Google images web site there is a good one there. For now it's on the first page, left side, third row down. I use this image when I teach. It clearly shows the line arching over the clavicle and dropping down to the left side of the heart.