Can a pt get a PE with a Picc line that has a miniscule opening?

[pookiesmom]

My question is this; my pt has a picc line, that I flushed with saline after his antibiotic to the cap end; each is one dose, so is disconnected from the line and minipump.

I did something dumb; (new to nursing); I reconnected the 'connector' (blue), to the cap end; thus creating an opening into the pt's Picc. (not sure why i did that)

I was told this could potentially cause an emboli b/c of this opening. My thinking is; nothing is actually pushing the air in; how could it actually seep in.

granted, I know this is not good practice of course.

also, this is a valved picc line; my understanding is that it is closed when it is not in use. so would this not support the idea that air would not get into the pt's arterial system??/

thanks from a newbie!

[gtoko]

I am not sure I am understanding your question. I thought you attached clave connectors,after removing the end caps,and then flush with saline,followed by heparin.. Its been awhile since I accessed PICC lines, things probably have changed.

[pookiesmom]

The 'blue connector (clave?), is the connection between the injection cap and the infusion set.

So, after I disconnected the infusion set from the injection cap, via the blue connector to flush the pt's picc, I then reconnected this blue connector. (with a male piece on either end; therefore an opening on either side)

does that make sense?

[canoehead, BSN, RN]

I don't get how there was an opening, but if there was, the breathing patient creates negative pressure in his chest with each inspiration, and air will go into any opening, including the PICC. If it was a small opening it would be a small amount, but with time it could cause a problem.

[pookiesmom]

Thanks for the reply's.

[P_RN, ADN, RN]

What was the brand of the connector?

[pookiesmom]

Sorry, I really don't actually know; this is in canada. it is a 'blue connector' with a male piece on either end; ie. connects to infusion line and connects to pt.

the Picc line is a valved one; ie; my understanding is it is closed when not in use.

I am still very afraid that this pt could get an emboli.

he was left for 7 hrs with this opening.

[icurn99]

Is this the cap you used? I'm not sure I fully understand what you did.

http://www.icumed.com/clave-connector.asp

[pookiesmom]

No that is not it. I will try and find it and post a picture.

[Sunnysidegirl]

Was the Picc a Groshong? I've read a little about this type of valved Picc and it is closed to air see the link below.As for the blue cap... I'm not quite sure I know what you are refering too.Hopefully the illustrations from the link may help.

http://www.bardaccess.com/pdfs/ifus/ifu-grosh-cath.pdf

[Zookeeper3]

If this helps you feel a touch beter, the central lines sit in the venous system before the right atrium. A small air bubble should be filtered through the lungs. A clot is a touch different and can clog up distal capillary bed leading to the alveoli. If it isn't a huge clot, the body will work to disolve it. A larger clot can get caught up in a larger pulmonary branch.

Now, I know very bad things can happen, it is unlikely though. We've all had our share of OOPS moments, keep learning from yours and your patients will be safe. THere is nothing wrong with asking an experienced nurse there to walk you through once more. I still grab a peer, a newer nurse and say "hey, come here at look at this...." thats 15 years in. So keep asking and learning:redbeathe

[pookiesmom]

Thanks that was very interesting and helpful! Another question I have is this: my pt's med Maperan (sp?), was to be premixed just before giving; ie. solute (powder), mixed via vial with minibag; both of these kept in fridge. I had mixed it; but dose was late; ie. not warmed up.

Can a pt feel any of this cold solution going in when it goes directly into the superior vena cava?? Just curious.

thanks!