PICC line dislodgement

[Blackcat99]

What are the usual signs/symptoms that you see when a PICC line is out of placement?

[IVRUS, BSN, RN]

What do you mean "Out of placement?" Are you asking what the signs and symptoms are when a PICC line migrates into a tributary vein, or migrates out of the SVC and into the Jugular vein? Or, are you asking what occurs when the line is accidentally pulled out 5 cm?

[Blackcat99]

Accidently pulled out.

[IVRUS, BSN, RN]

Well, it all depends on how much has been pulled out. If the entire thing is "out", You must measure it to see if it was the same length as what was placed, or in the case of a Groshong, look for the black tip, as it being there on its distal end tells you that it all came out.

If you were present when it came out, pressure should be applied to the site until hemostasis resumes. Now, if you aren't privy to what went in ( CM or Inches placed) then you will have to assess for "No jagged edges at catheter's tip to the naked eye" and your report to the MD, as he'll ask about the pt, and determine whether to send him or her for a CXR.

Catheter embolism s/s are varied. Some people show NO symptoms, others could experience hypotension, SOB, Chest pain.

If it has embolized, the MD will have to retieve it with a specially designed snare, going up through the groin in most cases, like a cardiac cath.

If only a portion was yanked out, one must determine the length of therapy and osmolarity/pH if the medication given to ascertain whether the line can be made a MIDLINE and continue therapy, or should the entire IV catheter be pulled and replaced?

Remember that NO IV catheter should stop, or terminate in any other vessel, besides the SVC if it is centrally placed. However, as mentioned, if the drug is a benign drug, and can go peripherally, the catheter could be pulled back till the tip is right before the Axillary vein, thus making it a Midline.

[beingcaitlin]

I think that if you know it has been dislodged you would stop the pump if it was running and you would need an X-ray to see where it was and then it would need to be adjusted accordingly by a picc nurse or someone qualified to tinker with it? There should be a sign above the bed with measurements of the line so if its questionable you should always measure it, you're supposed to measure it during assessment and document anyway. BUT this is just what I've been taught- I'm a student. Also hospital protocols may vary between institutions.

[TestifyToLove]

Protocal in our center is to measure the line from insertion site external length at every dressing change to be aware if the line is migrating. The original length is supposed to be documented when the PICC is placed. However, we have a very strange set-up and the home health team is the PICC team for the entire hospital system (multiple hospitals and outpatient facilities in the system around the city). If it migrates too far, our protocal is to immediately inform the ordering physician and allow them to make the judgment call on how to proceed. We have several options, including as mentioned making it a midline placement or sending them back for a re-insertion. We don't have authority to do or order any of the options without physician orders, however.