If your site is sterile and you have scrubbed and draped an area big enough to expose the brachial and basilic. You have tried inserting the PICC but it is unable to be placed correctly. The field has been maintained and the cath has only been exposed to the insertion site and the person’s vein. Is it prudent to use the same PICC for a 2nd attempt in a different vein or higher up the same vein? Or should you pitch the PICC and open up a new kit for the 2nd attempt?
Also, I have often had an intermittent blood return with an easy flush when I am too deep and in the atrium. (Navigator not used.) I have had this happen so many times I almost consider it a sigh that I am golden, just about 3cm too deep. I pull back 3cm and am at the junction. My friend disagrees, and says you get an intermittent blood return only if it is up the neck or some other incorrect placement. What are your thoughts? Question from NM on 5/5/2014
REPLY FROM NANCY MOUREAU:
The issues while working in a sterile field apply to OR practices and follow the lead of our physicians. A sterile field is a sterile field. If you have not contaminated then reusing a PICC for same arm insertion is reasonable. New arm, new field, new PICC.
About blood return, this is opinion but one correlated with a few other clinicians. Yes, you can get intermittent blood return just past caval atrial junction and free flowing in SVC or deeper atrial. Reply on 5/6/2014