You accepted the referral. Consented the patient. Inserted the Peripherally Inserted Central Catheter (PICC) to you your usual high standard. The X-ray was ordered and taken. Then dismay. The last few centimetres of the PICC is looped in the Superior Vena Cava (SVC). So what are your options? You could start over or you could remove the dressing and attempt to reposition. Some may suggest that better use of resources such as radiology imaging or tip location technology would have indicated the issue and allowed immediate correction.
What if you are faced with a loop in the end of your PICC within the SVC? One option is to administer a fast turbulent flush whilst simultaneously asking the patient to complete the Valsalva manoeuvre. Hopefully, when the chest X-ray is repeated the tip of the PICC will be straight.