Tuesday, 11 March 2014


A QUESTION FROM ONE OF OUR READERS (PLEASE ADD A COMMENT BELOW TO REPLY)

Hello

We have a patient with a single lumen 4Fr PICC inserted via right basilic vein and has been in situ about 4 weeks. Unfortuneately the PICC insertion details were not transferred with the patient from another facility so the date of insertion as well as the type of PICC and insertion details are not yet available.

 The PICC can be removed but it is stuck. After three different attempts to remove it failed (using heat to the PICC arm 20 minutes QID, having patient do active ROM, different patient positions, chest xray confirms no kinks or abnormality) an ultrasound was done and revealed a thrombus from insertion site to the junction of the right axillary vein and subclavian vein. Patient does not have any swelling distal to the PICC site.

A surgeon was consulted, the advice was to, basically, keep trying. Patient’s medical history includes Aplastic anemia with thrombocytopenia, which is curious as to how he got the clot in the first place.

 What else can we do?

Many thanks!

Renee Logan, RN, CVAA(c), CRNI
Parenteral Nurse
University Hospital of Northern BC

 

Posted by TopicsInVascularAccess at 10:09 AM in Questions from Readers

Comments on this entry:

Left by Cherylanne Perry RN,VA-BC at Tue, 11 Mar 1:42 PM

This happened to me once before.
I did not feel comfortable tugging the PICC, it was a silicone and not a power injectable PICC so i wasd afraid it would break.
I consulted the Interventional Radiologist and they removed the PICC under flour in IR.

Left by Danielle McClain RN, BSN at Wed, 12 Mar 4:59 PM

Our team also had this happen once. We also consulted the Interventional Radiology Team. They were able to remove under fluoro (basically they just pulled until it came out) and could see that all of the line was removed.

Left by Lori Brown RN CRNI at Thu, 13 Mar 8:57 AM

I have had this happen twice with PICC lines that have been in for several weeks and several months. Both patients had developed scar tissue at the insertion site that was basically adhered to the PICC line. One of them required quite a bit of effort to release the scar tissue and there was some bleeding post removal but healed well. Also, our team has been following VTE with PICC lines and we have found over the past approx 2 years that oncology patients even with severe thrombocytopenia tend to develop more clots with these lines. Go figure.

Left by Darilyn Cole, RN CRNI VA-BC at Fri, 14 Mar 5:48 PM

I haven't seen this in a long time. It used to be much more common when we placed PICCs in the AC into the cephalic vein. Have you tried giving the patient Valium and promoting relaxation?
If all else fails definitely refer to IR.
Good luck and let us know how it works out (pun intended)

Left by K Housman, RN at Sat, 15 Mar 3:34 PM

Interesting, no one has mentioned the clot. Have they been treating the clot? Perhaps once that has been treated, it will come out? We also refer to IR. With a known clot, I would not be removing that PICC, I would def. refer to IR.

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