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Discussion

PICC migration

How much PICC migration is acceptable and at what point do you need to be concerned and consider it's no longer SVC?

Recent patient was extremely active. PICC team (we outsource PICC insertion to the hospital system PICC team, which we are not) failed to write how much tubing was external at insertion. However, I was able to document 1.5cm weekly migration with dressing changes. Antibiotic and CRP levels remained in good ranges, but we discussed as a team that any further migration would need to be reported to the prescribing MD after the second week.

Patient d/c'd and it was no longer a concern for *this* case, but am interested in learning for future reference. He was our first PICC that was migrating at all. Most of our patients are very careful and protective of their PICCs and we never see little to no migration at all.

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    You would have to perform an xray to determine if the tip is still within the SVC, different people have different length and sized SVCs.

    We have policy that whenever there is PICC migration we image the PICC.

    It is extremely important to KNOW where that PICC tip is and KNOW that it is within the SVC. You really do not want to be infusing in the brachiocephalic vein and definitely not in the subclavian vein.

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    There should be no migration. If there is, it should be brought to the MD's attention. The PICC tip should be in the distal 1/3 of the SVC at or near the cavo-atrial junction. SVC's length vary per person, from 3cm to 12cm average. A small migration for one patient could be very detrimental. Prior to use, you should have documentation from insertion confirming where the tip is and what the external length was at time of placement/ release to use. If you do not have that, you should have a policy in place to get an x-ray to verify PICC tip location. Start your documentation there. If it does migrate out, contact the MD and let them decide, It is not only that the tip would leave the SVC, with the more proximal the tip is in the SVC, the greater the incidence of complications. And, of course, it should never migrate in - that would mean contamination of the PICC. Feel free to check with INS and AVA. Best wishes.

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    I'm a new PICC RN using the Bard system and when we are done with our insertion and getting ready to print/save our strip, the actual number of cm out of the site is documented on the strip and is also documented on the EMR in lines/devices category. (We use Cerner for EMR)

    Maybe for an active person, the PICC should be sutured in place vs just using a Stat-lock although the Stat-lock should help prevent migration in a perfect world.

    Isn't there a place that you can research the amount of line left out of the site?

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