need an iv answer please

Be_Moore · May 27, 2009

If the tip is in the brachiocephalic (also called the innominate), it means they probably undershot their measurements. the IJ combines with the Sub Clavian to create the innominate (brachicephalic). The innominate then turns into the superior vena cava.

As far as complications...you won't be able to transduce an accurate CVP. But otherwise the medication is still going into a large central vein that feeds directly into the superior vena cava and then to the heart. They should probably advance it some, however. I'm guessing this is a Left IJ because the right brachiocephallic is very short compared to the left.

IVRUS, BSN, RN · May 27, 2009

While Be Moore is correct in saying that the measurements were probably "undershot", Infusion Nurses Society Standards (INS) state that the tip should be in the distal SVC or at the Caval-Atrial Junction. This is the vessel which will provide the best hemodilution and decrease the irritation to the tunica intima because it has the best blood flow. In addition, one should never advance the IV catheter unless a sterile field has been maintained, and, this usually isn't the case. In most instances, the field is broken after the catheter is dressed which would mean that one couldn't advance the catheter after that point.

nminodob · May 27, 2009

By advanced I assume that what was meant was a new catheter was re-threaded and inserted farther until it reached the caval atrial junction. I am not a PICC nurse, but just had an in-service with our hospital's PICC nurse yesterday, and she told us that under no conditions would the PICC be used if it wasn't in the SVC.

Be_Moore · May 27, 2009

By advanced I assume that what was meant was a new catheter was re-threaded and inserted farther until it reached the caval atrial junction.

Correct. Colloquially we just say "advancing."

sweet sunshine · May 27, 2009

thanks for the replys, it was a left ij line. pt. had pe that was discovered 3 days later.

iluvivt, BSN, RN · May 28, 2009

Just want to add...that indeed it would increase the pts risk for developing a thrombosis....OK here is the deal on suboptimal placement on any CVC and that includes PICC lines..the issue does get a little thorny and the IV nurse,PICC nurse ,MD and when applicable must have a discussion for any sub-optimal tip placement. In some situations it is OK to se a CVC that is not in the low SVC if for any reason,usually pathophysiologic a catheter can not be advance deep enough AND all other options that could meet the pts needs are exhausted,,,YES you can use the line...just look at it this way...its the best that pt will get.....for example..they have 6 weeks of Vancomycin and you can only get to the brachiocephalic......pt only has one arm...bot you and intervention radiologist tried to place and it will not advance...OK notify MD...use and monitor pt for potential complications...also do your pt teaching so pt knows s/sx to report...so you see it is not always clear cut...always weigh the risks vs the benefit when you have these tricky clinical situations....We have had quite a few cases like this...we even had a PICC take a rather aberrant pathway for us and then the radiologist..the home care agency freaked out and would not take the patient until we got the radiologist to explain...this was the guys anatomy and this was the best we would get and he guy needed his abx