Watch your deeplines, guys!

[elizabells, BSN, RN]

Just wanted to share my nightmare from last night. I come in to a kid I know, who has a deepline (basically a failed PICC, but whatever) running TPN and dopa. PIV for meds, running Vanc when I came in. I go to do my first hands-on at 1945, and the poor little hand with the PIV looks like a sausage. Clamp it off, call the resident, she comes with Wydase at 2100 (got waylaid by some needy parents on the way). I'm on the other side (the side with the deepline) holding baby down, and I look down at the arm and shoulder... and oh my lord, the edema and blanching...

I didn't sit down until, hand to God, 0130. Access nightmare. Ended up running the TPN to the UAC (it was only D9ish) and just forgetting the dopa. Took two MDs and two NPs over two hours just to get another PIV for the abx. 0.1mg/kg of morphine x 2 did NOTHING.

Moral of the story: Deeplines are not PICCs. They can and will infiltrate on you.

[bayouchick02]

is a deepline the same as a "longline". They're like a picc line but dont go as deep as a picc does??

[BittyBabyGrower, MSN, RN]

We call those midline PICCs. We can't use them for anything but IV fluids and a handful of meds, no vasopressors, vanco, etc. And we only leave them in for 7 days.

I really hate when you have a kid like that and they don't have a central line....totally irks me!

How's his arm today?

[TiffyRN, BSN, PhD]

We get them off and on; always failed PICCs. We are to treat them like PIV's. We have had them infiltrate. But we've had CVL's infiltrate for no good reason. Some have good reasons like the kid way outgrew the line.

[SteveNNP, MSN, NP]

I've never understood how a soft, floppy dental-floss size catheter manages to poke a hole in a vessel wall and migrate out. It happens, but doesn't make sense.

[preemieRNkate, RN]

Ugh, I've had that happen. It really stinks (for us and the baby!). Last time it happened, it was a PICC that migrated. I noticed it as I was getting report, I said something to the nurse that was leaving (I said something about the baby's neck being all huge and blanched and purple-ish). She said something to the effect of, "Oh, she's kind of edematous." I was like, "Uh, I think that's more than edema." What a nightmare that turned into. Same thing, had to run the TPN through the UAC and the NNP tried to get a new PICC forever. I finally managed to get a PIV that somehow lasted the rest of my shift and most of the next, until they were able to get a Broviac in her.

[BranRN]

I've never understood how a soft, floppy dental-floss size catheter manages to poke a hole in a vessel wall and migrate out. It happens, but doesn't make sense.

Hey, thought i'd share a story here.

I have seen IL in a spinal tap from a Picc that had migrated into the spinal column....um no wonder the baby crumped out. We now do ap AND cross tables on all lower extrem. PICC's for placement.

[2curlygirls]

We once got IL out of a chest tube!!!!!

[dawngloves, BSN, RN]

So true! We treat non central PICCs the same as a PIV and we check our PICC sites as often as a PIV because they do infiltrate and I've seen some ugly ones.

BTW, do your docs only administer Wydase??

[Mimi2RN, ASN, RN]

I've never understood how a soft, floppy dental-floss size catheter manages to poke a hole in a vessel wall and migrate out. It happens, but doesn't make sense.

It's so nice to know we are not the only ones having weird PICC infiltrates!

[Sweeper933]

We once got IL out of a chest tube!!!!!

Nice.... :chuckle

[elizabells, BSN, RN]

So true! We treat non central PICCs the same as a PIV and we check our PICC sites as often as a PIV because they do infiltrate and I've seen some ugly ones.

BTW, do your docs only administer Wydase??

As far as I'm aware, yeah. When I called her she just said she'd order it and be over, and went ahead and did it.

We treat deeplines like PICCs here, except for the allowable Dex concentration in fluids. Clearly that worked out well. The two times I've seen this happen the kid was getting Dopa through the line, but not at any higher of a concentration than we'd run through a PIV. Maybe it gets so ugly because there has to be a BIG infiltrate for the shoulder to swell like that. It's not like a PIV where the end of the catheter is close to the surface.