Would you use a sub-clavian heading towards the head?

[ukstudent]

Would love to get some feed back.

How many have, when the central line has taken a wrong turn towards the head instead of the heart, then had orders to use that line?

What, if you have used that line, have you run through it?

Would you feel comfortable running vasopressors though it?

[hypocaffeinemia, BSN, RN]

Where does the CXR place the tip?

[ukstudent]

It was not my pt, but I believe it was in the internal jugular.

[cardiacRN2006, ADN, RN]

Nope. We had a picc that whipped up into the IJ, and we had to pull it and get an order for a new one. I certainly wouldn't put pressors in it either...

[hypocaffeinemia, BSN, RN]

If the tip of the line was in the IJ and running counter to the flow of the vein (if I understand your description properly), I wouldn't use it unless it was the only access during a code situation. Better still would be a bit of questioning why and who placed it like that and left it there after confirming it was in wrong.

[cardiacRN2006, ADN, RN]

Better still would be a bit of questioning why and who placed it like that and left it there after confirming it was in wrong.

Sometimes they can migrate there (heavy coughing is one way) after placement. The one that I had that was in the IJ migrated there a few days after placement. It was caught in the routine am CXR.

[hypocaffeinemia, BSN, RN]

Sometimes they can migrate there (heavy coughing is one way) after placement. The one that I had that was in the IJ migrated there a few days after placement. It was caught in the routine am CXR.

I should have said or.

Regardless, if they have it on CXR that the tip is in the IJ, it shouldn't be used (unless, like I said- code and no access).

[cardiacRN2006, ADN, RN]

I agree. When I got the call from the radiologist that morning, I had to disconnect, change out to another IV, start another IV and pull the picc. It was a crappy way to start the day!

[ukstudent]

It was a new placement, left in and the nurse was ordered to use it. The pt also had one peripheral.

If in this case you had one central heading towards the head and peripheral and needed to give pressors, what would you do?

[hypocaffeinemia, BSN, RN]

It was a new placement, left in and the nurse was ordered to use it. The pt also had one peripheral.

If in this case you had one central heading towards the head and peripheral and needed to give pressors, what would you do?

If the doc was adamant about using an improperly placed central line, I'd go up the chain of command to charge nurse and so on, and also write an incident report. Meanwhile, if the patient's pressures were tanking I'd stat page the attending (if it isn't the doc ordering to use the line) and get someone else to put another line in while I fluid bolus the peripheral.

Of course, I'm just a student who happens to work in an ICU, so my answer is hypothetical and not based on actual nursing experience (soon!).

[cardiacRN2006, ADN, RN]

It was a new placement, left in and the nurse was ordered to use it. The pt also had one peripheral.

If in this case you had one central heading towards the head and peripheral and needed to give pressors, what would you do?

I'd run the pressors in the PIV and refuse to use that line. It wouldn't be pretty. And I'd start looking for spots to slap a big 18g in while I figured out who I was going to complain to next. I'd also get my charge nurse involved, and get her opinion.

But, it all depends on the pt situation as well. If things are going to hell in a handbasket quickly, then you do what you gotta do.

[SWEnfermera]

If I had a PICC line or any other central line that flipped up into the pt's IJ I would definitely not use it to infuse pressors, however I would not pull the PICC as this can be easily fixed.

The PICC nurse can easily pull the PICC back aseptically around 5cm and re-advance it. They elevate the patient's head a little (gravity helps the line travel in the right direction), and then they have the pt turn their head toward the affected IJ while advancing and simultaneously flushing the line. This helps to occlude that IJ and helps the PICC turn down into the SVC.

PICC lines can be confirmed in the right position by CXR and then can easily flip into the IJ. This is especially true for obese and large-breasted women. If they lie on their side the weight of their skin can pull the pick out of place, and then when they turn back, the PICC can turn up in the wrong direction.

If you flush your PICC line with saline, and the patient tells you he/she hears a swishing sound in their ear, be suspicious that your line has migrated, and get a CXR.