RE: shearing of guidewire

[Earhart, Ann]

Sorry everyone, have been out piccin and a grinin.   Our team has actually had this several times, more with one brand of catheter than another.  I best clarify a couple of things.   I’ve seen 5 catheters over my 13 years placing PICCs do this. Only one patient ended up with arterial emb. The tubings were all unclamped when pulling the stylet. All the tubings were primed with saline. We did not pull the stylet through the rubber stopper, we unscrewed the cap to remove the entire device.  One catheter was trimmable, we did not cut the wire.  The others were non-trimmable. One catheter was coiled in the chest post placement, which probably was the reason for the difficult removing the stylet, the others were all SVC and not coiled. Can you tell I’ve had these questions from the manufacturers thinking we did something wrong.  I can’t blame them.  I do the same when I get called to help declot central lines-looking for kinks, not flushing enough….I do the same.    When we finished placing the PICCs, we would go to pull the stylet, and it was stuck.  The thought was the catheter was coiled in the chest, so the catheter was repositioned.  After repositioning and the wire was still stuck, so an x-ray was ordered. All but one PICC was straight and in the SVC.  The coiled one we knew why it was stuck.   (I’d like to clarify; I’ve only seen 5 catheters do this).  We took these patients to Medical Imaging and we let the Radiologist pull back on the stylet, and the stylet came uncoiled inside the PICC and patient.  What happened, some of these stylets are wires that are wound together, so if one part sticks to the side of the catheter, the other 3-4 wires become unraveled. It hasn’t happened on the larger lumens, but it has on the 3 single, 4 single, 4 double, 6 triple, I’ve seen this on 2 different brands of catheters.    I’m sure it has to do with the size of the smaller lumen and the wire.  We’ve checked out lot numbers.   One product we ended up switching away from due to the wire sticking and uncoiling inside the patient on several occasions.  We even pulled the picc out hoping the wire would follow…it didn’t.  Our one lost wire was similar to Pam’s. We couldn’t see it under the x-ray, it was too small.  It wasn’t until the patient had a procedure in angio that they were able to see the wire, and they retrieved it then.  It was a small, one wire, 10cm section that had broken off.    Our lesson, just like it Foley catheters and we blow up balloon first to make sure inflates and deflates, we flush catheter with saline, and make sure the wire is movable before we insert into the patient AND be very careful when you go to pull back a stuck stylet.     Ann Earhart, MSN, CRNI Medical Imaging Clinical Infusion Specialist-PICC Team Banner Desert Medical Center Mesa, Arizona  85213 office-480-512-3980 pager-602-420-3240 e-mail:  [EMAIL PROTECTED]   From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of pam michael Sent: Wednesday, July 19, 2006 8:38 PM To: [EMAIL PROTECTED] Subject: shearing of guidewire   Sorry about the terminology. Yes it was the stylet that sheared.  The wire was retrieved without incident, and apparently was approx. 8" in length.  So back to the original question, has anyone else had that experience? Pam