During a PICC procedure how to deal with the situation when catheter is miss inserted into v.jugularis interna? How to avoid from happening is it possible of using a pressure sensor to track the tip of catheters location by using the different flow directions and speed in the blood vessels
First, always try to use the basilic vein for PICC.
If is miss inserted in to jugular vein, there are some tricks you can make:
1- Ask the to pacient rotate his neck ipsilateral
2- Ask the patient to abduct the arm involved in the procedure
3- Ask the patient deep breathing (advance during inspiration)
4- Use EKG guide
5- Use X-ray guide
6-Use Sherlock device
I hope it helps you
Turning the head on same side and abduction of arm helps in preventing movement of picc to ipsilateral ijv
You can track it by contrast injection into the peripheral port and veiwing it under flourscent image
compression at base of neck where IJV meets subclavian vein along with ipsilateral neck movement also prevents migration into IJV.article about same is published by prabhakar et al in BJA.
Agreed, manual compression of the IJV or turning the head towards the imsertion of the picc may help. If done withiut floroscopy ab US over the IJV can help identify if the catheter is still heading up the IJV.
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