I've been putting in PICCs for nearly a year now. Yesterday, the darn thing tied itself in a knot about an inch from the tip! I couldnt remove it from his arm, so the patient had to be sent to IR to have it snared. The PICC went in so easily, didnt get hung up at all, and it was a straight shot down the svc. Has this happened to anyone?
Apr 10, '10
I have seen a lot of loops....what I think happened is that somewhere in the course of threading it perhaps as it took the turn into the SVC it made a little pretzel and as you advanced it it made that loop into a knot....it would be interesting to know .....what side were you on?..what vein were you in? and did the pt have any rhythm devices..old or new in place or any history of chest surgery or pathology?
Apr 11, '10
I went into the left basilic vein, which was larger that what i usually deal with. No history of surgery, pacer or ICD. It was a 6 fr picc. The picc wouldnt flush after placement, nor was there a blood return. I pulled it back, thinking maybe there was a kink. It still wouldnt flush, so I decided to swap it out. I cut the PICC and rewired it. The wire wouldnt advance as it should have, based on measurement. It wouldnt come out of his arm, so I decided to get an xray. The knot was nearly 3 mm.