Infiltration/extravasation injury can occur with any CVC including
PICCs due to the formation of a complete fibrin sheath along the
entire length of the catheter. The infusing fluid will flow
retrograde and leak out the insertion site. For a midline, there is
serious concern over the possibility infiltration because the tip is
still in a peripheral vein and the vein is deep. If the basilic vein
is used, the vein is underneath the muscles of the arm, meaning that
it will go undetected for a much longer period than the same
infiltration from a short PIV. Also there are larger nerves and
arteries at the midline tip location that can be damaged if
infiltration should occur. With that being said though, the actual
risk has not been quantified by research. So I can not quote a
specific infiltration rate with midlines, but the concern is a much
greater risk if they should occur. Lynn
At 8:44 AM -0600 3/8/06, Erickson, Wendy wrote:
I think I am missing something here. How would a midline/PICC
infiltrate/extravasate? Have you actually seen PICCs go thru a vessel
into the subq tissues? I am not clear as to how this would happen. You
enter the vessel well below where the tip is located, you get a blood
return, you have an xray confirming correct placement. If a pressure
infusion ruptures a catheter, the fluid would leak out into the blood
stream. The only way I can visualize this happening is an actual
rupture of the vessel itself, or somehow the PICC passes thru the vessel
wall? I have never considered infiltration of a PICC a possibility,
unless the PICC has been pulled almost all of the way out of the vessel
and is in that small space between the level of the skin and the vessel
itself. And if that is the case, I can't imagine anyone in their right
mind using it for anything! Please clarify this for me - how can a true
infiltration occur?
Thanks!
Wendy Ericksoon RN
Luther Midelfort - Mayo Health System
Eau Claire WI
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Heather Nichols
Sent: Wednesday, March 08, 2006 7:32 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE:Unable to get PICC into SVC
Leave the line as is and send to IR for readjustment if it can be done
within 12 to 24 hours, or remove and try another site. The line should
not be used until it is in good tip position. If it is pulled back and
left as a midline, nothing should be given through it that you cannot
give through a regular peripheral IV site. Infiltrations are
particularly hard to see with a midline until it is too late. At least
with a peripheral IV site, you can usually see it happen right away.
Midclavicular are bad news. An infiltration or, God forbid, an
extravasation, will not be seen until the damage has been done, and the
damage will be in the subclavian. You only have one on each side. It
is not like the extremities where we have plenty to ruin. We actually
had midclavicular line removed from our Kentucky state boards decision
tree and opinion statements with no problem since there was tons of
evidence to show how dangerous midclavicular lines were. Let your
doc's know about this. They probably have no idea.
Heather Nichols RN BSN CRNI
Infusion Services
University of Louisville Trauma Institute 530 S. Jackson St.
Lou. Ky. 40202
(502)562-3530
"Patty Flack" <[EMAIL PROTECTED]> 3/5/2006 2:39 PM >>>
I had a patient last week in ICU who had a PICC line ordered, but PICC
kept going into the IJ after 3 attempts to get it to go SVC. I ended up
pulling the PICC back to a Midclavicular tip placement. This hospital
does not have IR and the infusates were irritating in nature.
I have come across this situation in the past and have been directed by
MD's to leave the line Midclavicular. My supervisor says to always pull
back to midline and schedule patient for IR. I would like to know the
opinion of those who are more experienced than I.
Thank you in advance,
Patty Flack RN
-----------------------------------------------------
Confidentiality Disclaimer
This message, including any attachments, is confidential, intended only
for the named recipient(s) and may contain information that is
privileged or exempt from disclosure under applicable law, including PHI
(Protected Health Information) covered under the Health Insurance
Portability and Accountability Act (HIPAA) of 1996. If you receive this
message in error, or are not the named recipient(s), please notify the
sender or contact the University of Louisville Health Care I.S. helpdesk
at 502.562.3637 to report an inadvertently received message.
********************Confidentiality Notice********************
This message is intended for the sole use of the individual and
entity to whom it is addressed, and may contain information that is
privileged, confidential and exempt from disclosure under applicable
law. Any unauthorized review, use, disclosure or distribution of
this email message, including any attachment, is prohibited. If you
are not the intended recipient, please advise the sender by reply
email and destroy all copies of the original message. Thank you.
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
