We have a pt with a PICC for anti-emetic admin. due to hyperemisis gravidarum; line inserted in Jan. No problems until recently c/o "feeling and hearing the flushing sound in my throat" when her PICC is flushed with NS. Happens ~ 3 out of 5 times the line is flushed. CXR done yesterday indicates mid SVC tip placement (has dislodged ~3 cm). Flushes well-good blood return. ABG done to r/o arterial placement. ? fibrin sheath or hole in catheter. Will speak with radiologist re catheterogram- pt may be hesitant due to pregnancy (29 weeks) (will check with radiology re contraindication of dye in pregnancy).
In the interim, pt is continuing to use PICC after risk/benefit analysis discussed with patient. Patient does not want another PICC. Instructions given to pt to report any signs of thrombosis immediately. Was going to suggest routine CXR; however unfortunately the xray tech scared the poor woman literally to tears informing her about fetal risks of xray exposure, despite having the apron on.
Any thoughts? Could it be the preservative in the NS? If so, what do you flush with?
Looking for ideas on how to best handle this.
Many thanks!!
Daphne Broadhurst
Ottawa, ON
