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Discussion

PICC Infiltration!!!

So I had this patient this last weekend that needed a PICC placed because his veins were shot from the IV Vanco he was recieving for cellulitis and being a past IV drug user. So about 10:00 that morning he gets his PICC. Placement looked good, he had no concerns or weird feelings. So we went throughout the rest of the day no problem. He was getting TKO with a rate of 20 throuh out the day just fine. Then night shift comes on. At about 2000 they administer his Vanco IV. It was mixed in a 750 ml NS bag. When the RN came back in the pt. was complaining of his neck hurting and it getting hard to breath. Sure enough when the nurse looked he had a HUGE swelling on the left side of his neck. Huge like a goiter! So they D/C the PICC, tried and IO which didn't work and finally got a TLC in his right groin. While the Dr. was trying to get all this done one of the nurses was calling all kinds of specialist to find out what they should be doing since the Vanco is so toxic. NOBODY knew what to do. They would be told to apply heat and then somebody else would call and say no, apply ice. This went on for about 2 hrs. We moved him to ICU for obbs. When I came back the next shift I was at a lost. NOBODY had heard of this happening??!!! So I was just wondering if any of you have seen this or heard about it and knew what could be done for this pt. or in the future should this happen again. Thanks!

Featured Replies

Did they do an xray to confirm placement? We always do a chest xray for confirmation before using it.

But no I"ve never heard of it.

Tiger

  • Author

The PICC was placed ultrasound guided, and yes there was a x-ray to confirm placement. Thanks!

My thought would be there was a defect in the PICC line somewhere. I would be willing to bet there was a tiny hole in the line somewhere around the neck. Hope they kept the line, I would see about having it examined. But, to answer your question, nope, never heard of it.

It is pretty rare, but unfortunately it can happen. I have seen 2 different TLCs become displaced. The one lady started puffing up and the other one we just noticed that the medications stopped working. Thank goodness neither of them were receiving medications that were really hard on the muscles! Just make sure you visualize the area and feel for infiltration like you do with a peripheral IV.

PICCs will migrate out of place sometimes and this sounds like it migrated into his jugular. Once there, it could have irritated an already compromised venous system and rubbed a hole in the jugular, causing the infiltration. I have had PICCs migrate like this, happens tho rare. One reason to assess PICC sites the same as any IV site. Previous IV drug users can have long term inflammation of their circulatory system which makes their veins very friable or fragile. How was the vanco infiltration handled?

I've seen them infiltrate a few times. As far as I know, they were all due to a defect in the line.

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