Strange symptoms after flushing PICC....suspect arterial placement?

Posted
by HeartRN_09 HeartRN_09, BSN Member

Specializes in Cardiac step-down, PICC/Midline insertion. Has 10 years experience.

Just wondering if any of you have ever taken care of a patient that had a picc line inadvertently placed in the artery and what symptoms the patient had, specifically when flushed or during or after an infusion?  I don't honestly see how this can happen, but I know it does happen and we have a patient on our services right now that we are suspecting might be an aterial placement because of the bizarre symptoms that are occuring with the pt.  (We didn't place the line on this one!!)  I've been doing search after search trying to find a case study or anything helpful to explain this pt's symptoms that occur 1-2 hours after the line is flushed. (chills, rigors, headache, nausea/vomiting, coldness in extremities, fever, runny nose, and sometimes chest pain).  I've been a picc nurse for 4 years now and I have not heard of or seen anyone experience these symptoms before.  I'm going out today to remove the line from this patient and I'm going to look at it with my US before I pull it out of curiosity.  

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

It's certainly worth investigating many of those symptoms, but having them occur 1 to 2 hours after flushing the line does not in any way suggest arterial placement, and really even if they occurred sooner after flushing they wouldn't suggest arterial placement.  How did you come to that conclusion?

LeChien, BSN, RN

Specializes in Emergency Nursing, Pediatrics. Has 10 years experience. 278 Posts

What are they actually receiving through the PICC (I.e. antibiotics)? Or are you only flushing it for maintenance?

HeartRN_09

HeartRN_09, BSN

Specializes in Cardiac step-down, PICC/Midline insertion. Has 10 years experience. 109 Posts

My boss read a case study about a patient with an arterial PICC and that particular patient had symptoms that were similar, although it didn't make much sense to me.....I would tend to think the symptoms would be instant with an arterial placement.   I was more concerned about a sensitivity to materials in the line itself or infection.  

The line was not arterial.  I confirmed that with US.  It was clearly in the basilic.  

Pt was only flushing the line for maintenance at that point which is why we opted to remove it.  

 

 

frozenmedic

frozenmedic

58 Posts

Is this patient in-hospital? You could transduce the PICC and look at the resulting waveform; this will give you a good idea as to whether it's arterial or venous.

eileendg1989

eileendg1989, RN

Specializes in Emergency Room. Has 7 years experience. 18 Posts

It is possible that the PICC line itself actually has an infection, doctor may want to insert another picc itself in a different site and culture the tip of the old picc line.