During picc insertion, picc nurse was inserting picc with sherlock wire into sheath.Sherlock sensor indicated picc was not advancing into svc as expected.Withdrew sherlock wire, wire would not retract.Advanced picc was then able to retract wire.Inserted stiff wire into picc, advanced catheter easily over stiff wire.Examined tip of sherlock wire to re-insert for tip placement confirmation, noted that magnetic tip was missing from sherlock wire.Retracted picc, capped dilator and replaced it into sheath.Flushed picc catheter to determine if magnetic tip fragment was inside, tip not found.Informed md, obtained stat shoulder x-ray revealing tip fragment overlying expected area of axillary vein.Successful retrieval of fragment in the region of the right axillary vein/subclavian vein and placed picc line with fluoroscopic guidance.
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