PICC in wrong place

[mistymae22]

Hi, I had a patient recently and I was giving blood through the PICC. I forgot to get an order for chest X-ray and to get doctor to verify PICC placement before continuing to use. When I went on shift the previous nurse was already using the PICC for blood. As well as other nurses before him. I was so busy and slammed to see if there's an order to use PICC. Well charge nurse picked up on it and we got an order for chest X-ray. PICC ended up being in wrong place. But meds and blood were already given through that. Patient seemed fine and no emergency happened but what could happen if you give meds and blood if PICC is not in right place?

[blondy2061h, MSN, RN]

We don't reverify PICC placement on readmission. All of our PICCs are placed in interventional. They write the "okay to use" order. We only re-check ones placed at outside facilities. Our PICCs are sutured and we'll x-ray if the sutures are pulled or if blood return isn't good.

[IVRUS, BSN, RN]

We don't reverify PICC placement on readmission. All of our PICCs are placed in interventional. They write the "okay to use" order. We only re-check ones placed at outside facilities. Our PICCs are sutured and we'll x-ray if the sutures are pulled or if blood return isn't good.

Well, I see this as problematic. "Okay to use" verbiage from a Radiologist can be that the tip is anywhere fromt he subclavian to brachiocephalic to the Right Atrium. So, the nurse takes this information, not really knowing where the actual tip is, and uses it and the patient is harmed: suffers a fatal arrythmia or cardiac tamponade from the tip being in the RA, or develops a Thrombus from sub-optimal placement, either scenerio, it's your liability.

In addition, migration of a central line can occur and be problematic. There seems to be a false sense of security here just because IR places them.