opening clogged PICC, with a wire????

[SWAT_RN]

Howdy all, recent events make me have to ask...

I was taught if a PICC became clogged, non-functional, get the order for tpa and follow p&p yada, yada. Well, we tried that x2 and the sucker was still plugged tight. I'm thinking it's going to need to be replaced. We contacted the IR staff and one of the techs came up to the ICU and pushed a wire through the obstruction. This opened up the PICC but I have to wonder about the safety of doing that. The INS reference I have doesn't mention this as an option and a quick internet search didn't turn up anything either. This particular tech has a VERY confident, superior demeanor and I just wonder if this is an acceptable solution to this issue.

Thanks for your input!

[jer_sd]

I think one aspect that may increse confusion is that in my experience few radiology employees including RNs are that well versed on INS standards. I have not read them for several years.... considering I place central lines I should review them since I am still a nurse I could be held to thoes standards.

I think the concensus of this thread so far is that you should avoid releasing embolic material into the blood stream whenever possible. The facility in question should address the role of the rad tech, rn and radiologist to increase communication and reduce potential conflicts with nursing staff out of the hospital.

I come from a radiology background and we constantly release embolic material into the vascular system, everytime we revise a dialysis graft/fistula, and small dvts below the knee are not usually treated ect... but best practice woudl be to remove a clotted line and replace if possible, some patients run out of veins even with ultrasound and x-ray (intercostal piccs are not fun cases). Was there ever clarification if the tech was acting under orders from someone or did this on his own accord?

Jeremy

[PICC ACE]

Wow. Talk about risks outweighing benefits! Catheter rupture,catheter embolism,wire embolism,vein perforation,pneumothorax,sepsis and I could go on. I can safely say that guidewires are not labelled for such a use and that PICC IFU's do not include roto-rootering with a wire. A reasonable and prudent act? Not by a long shot.