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.
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??
We use Amphadase asap, and it's usually given by the RN, after we get the stat order. We haven't seen Wydase since it was discontinued, but they may have come out with a different formulation. The Amphadase works very well.
It may well have been Amphadase; we use generic names and I'm just used to calling it Wydase.
We actually don't use it all that often, but I'm seeing it more and more lately. Like we just caught on or something. I don't know why the MDs/NPs are the ones who do it, maybe because we give subQ injections so rarely. Haven't given one since I've been in the NICU, actually.
Hey....were they positive it was IL thru the CT? We had that once and thought the same thing...turned out the kid had a chylothorax! We freaked when they hooked up the CT and this white stuff came out...we thought for sure it was lipids..turned out to be chyle!
We have had lines infiltrate...one kid it infiltrated and caused a cardiac tamponade, the line had migrated and somehow infiltrated. That kid flatlined and that was that
We use Amphadase asap, and it's usually given by the RN, after we get the stat order. We haven't seen Wydase since it was discontinued, but they may have come out with a different formulation. The Amphadase works very well.
I call it Wydase out of habit. We do use Amphadase. Every pt has a standing order for it though and the RN's give it. Works wonders on PIV infiltrates!
We have had lines infiltrate...one kid it infiltrated and caused a cardiac tamponade, the line had migrated and somehow infiltrated. That kid flatlined and that was that
We had an atrial line infiltrate on a kid getting prostins...poor thing was gone before we even realized what happened.
Mimi2RN, ASN, RN
1,142 Posts
We use Amphadase asap, and it's usually given by the RN, after we get the stat order. We haven't seen Wydase since it was discontinued, but they may have come out with a different formulation. The Amphadase works very well.