Picc line accidentally pulled out 5 cm.

Just to preface, I'm not a vascular access nurse and all of my experience is in NICU/PICU, where being out 5 cm is a way bigger deal than in adults.

That said, I'd probably inform the provider so they could order a follow-up x-ray to ensure that it's still in an appropriate place, or to verify that it's still ok to use if it turns out that it is low-lying.

I'm a bit confused about the question--are you saying that it pulled out on its own (i.e. not during a dressing change)? If so, I'd check the integrity of the dressing. If it's getting pulled out with regular use in such a short time, maybe you should look into using tug-proof dressings. You could also do some patient education on how to move around/position in order to prevent tugging. When you dress the PICC, try to make sure the end of the catheter that's outside of the skin is curled instead of straight; that way, if the line is pulled, it won't pull straight out.

This is one of the reasons it's really helpful to note how many cms out your PICC is when it's first placed and dressed. Without knowing how far out the line was when it was placed, it's almost impossible to know if it's slipped (and if so, how far).

XR to verify placement. It may still be ok to use.

KelRN215 said:

XR to verify placement. It may still be OK to use.

Might be able to re-wire and advance as well.

Yes.. As Wuzzie said, THIS IS A NO-NO!! Once sterile field is broken, one can NEVER push a catheter back in.

Chest x-ray to determine placement. We measure all our PICCS on admission so we have a record of what it looked like and we measure once a week with dressing changes. Anything different than the original measurement we call the doc, get a chest x-ray and go from there.

Wuzzie said:

This is highly frowned upon. Risk of infection is just way too high. In my facility a 2cm variance (out) is allowed. Any more and a CXR is obtained. If the line is mal-positioned it is pulled and replaced.

Fine...prep the area, run a wire up the existing catheter, take it out and run a new one over the wire. Take a picture for placement. Doesn't have to be a big deal.

This is ONLY acceptable in the few hours or a day after placement. Doing an exchange is not an acceptable practice once the catheter has been dwelling for some time.

We do wire exchanges fairly regularly at my facility. Not a single one of them has resulted in a Clabsi. When proper sterile technique is followed the risk of infection is not much different than an initial insertion. That being said....we don’t exchange if the site has drainage or just looks bad, proper care/maintenance of the line is questionable, they went home with it and came back, etc.