Re: "flushing sensation" in troat area when line flushed

[InfusionTx]

Until you do a dye study you have no way of knowing if there is a sheath or hole in the line. That is why I typically do not do simple X-ray. 9 times out of 10 you are going to have to do the dye study so why subject patient to cost and inconvenience of an additional test? You are really dead in the water until you have all your data in.   Risk of various dye options should be an easy answer from radiology.   We quit using preserved NS years ago. PF is available in a variety of forms to fit almost every conceivable practice setting. There are prefilled syringes, 10 and 30 ml single use vials, or pharmacy can use a hood to prefill syringes or prepare a patient specific multi-dose bag using a one way valve. Your needs and institutional polices will dictate which options are available to you.   Although I doubt the preserved NS is your problem it just seems better to avoid whatever theoretical or minor risk there might be by using PF across the board for all  patients.   Good luck, love to hear how it turns out.   Tony West, RN, CRNI Healix, Inc. Email: [EMAIL PROTECTED] or [EMAIL PROTECTED] SMS: [EMAIL PROTECTED] Cell: 214-674-4848     In a message dated 4/11/2006 6:47:43 P.M. Central Daylight Time, [EMAIL PROTECTED] writes: 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