I don't know if he moved his arm at all,if so it couldn't have been much
since he was pretty weak. Symptom wise,he had been in AFib for a while and
was on Amiodarone. While we were there he was SR with some PAC's,as he had
been all day. He was on the balloon pump before and after surgery. Not sure
what his EF was,but he certainly had plenty of other reasons to crash.
It was just hard to spend nearly 2 hours with a fellow and his wife and
daughter,then moments after leaving them be back pushing meds through one of
our lines. I,too,think it highly unlikely that the PICC's had anything to do
with the code,but no way to know with absolute cetainty....
Thanks for the responses.
D
From: "Lynn Hadaway" <[EMAIL PROTECTED]>
To: "DAVID LONGSETH" <[EMAIL PROTECTED]>, [EMAIL PROTECTED],
[EMAIL PROTECTED]
Subject: re: Telemetry and PICC's
Date: Fri, 19 May 2006 09:32:41 -0400
In what way did the patient move after insertion? Sit up, stand up, walk
around, or just move his arm while in bed. PICCs are known to move, so arm
movement could have caused the catheter tip to move into the heart. Or
indeed it could have simply been coincidental that this event occurred
immediately following the PICC insertion. Were there any other signs or
symptoms before the Vfib? Lynn
At 6:49 PM -0500 5/17/06, DAVID LONGSETH wrote:
Hi all-
First timer poster so hope this works.........
I was training a new PICC'er today,his first time after our class and a
few observed placements. Our third call was to the SICU and on the way I
commented that that unit was my favorite to place PICC's--spacious
room,plenty of extra sterile gloves in the room and the telemetry is right
above the bed.
Patient was POD3 after a CABG X 5 and after having MI symptoms for almost
a month,so both ventricles were plenty stressed.Extubated about 1 hour
before we got there. Patient needed 2 lines,so we gave him a 5FR Groshong
on the left and a 4FR single in the right. Both placements relatively
routine. Our CXR's get developped right outside the unit so I had a chance
to see the film before the Rad and the right PICC was a little too deep. I
had the new guy pull back 5cm right away--when the Rad called,he said it
needed to come back 6cm,so we pulled out another 1cm before we dressed it.
I glanced at the monitors a number of times while we were there--nice NSR
and good pressures all the time.
We dressed the lines,finished up paperwork,updated his wife on the
successful placements and went to the next customer 4 doors down.
We had just started to look at the next patient when the bells went off
and the previous patient coded--nurse there said he coughed a few
times,went into VFib and that was that. We hooked up his ext. pacer right
away and got decent pressures again.
Now,there were no arrhythmias during placement of either PICC. None while
the right one was too deep and none after we were done. The SICU
nurse,also a PICC inserter,didn't think our lines had anything to do with
the code and the CV surgeon didn't either. Just wanted to hear what you
all might think....
Thanks,
David Longseth,RN
L'As de Piques
--
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
