Now how did that happen!

I have seen a lot of loops....what I think happened is that somewhere in the course of threading it perhaps as it took the turn into the SVC it made a little pretzel and as you advanced it it made that loop into a knot....it would be interesting to know .....what side were you on?..what vein were you in? and did the pt have any rhythm devices..old or new in place or any history of chest surgery or pathology?

I went into the left basilic vein, which was larger that what i usually deal with. No history of surgery, pacer or ICD. It was a 6 fr picc. The picc wouldnt flush after placement, nor was there a blood return. I pulled it back, thinking maybe there was a kink. It still wouldnt flush, so I decided to swap it out. I cut the PICC and rewired it. The wire wouldnt advance as it should have, based on measurement. It wouldnt come out of his arm, so I decided to get an xray. The knot was nearly 3 mm.