Has anyone ever experienced a pleural effusion with a PICC insertion? There was an incidence in our hospital where the PICC was inserted and was maintained for a week in the CCU. Patient was in the hospital for diverticulitis, she was discharged and later followed up with her surgeon complaining of upper right shoulder pain and chest discomfort. Patient claims that she experienced these symptoms post picc insertion, No staff documented these complaints as well as our unit receiving any complaints either. She went for a chest xray during her MD visit and it was found that she had a pleural effusion (blood). she had no other procedure during her admission and the MD was questioning if the PICC insertion could have caused this incidence. I really could not imagine it, the only possibility I thought of was if the PICC position was proximal up against the vessel and it extravasated due to a vesicant therapy. She was receiving dopamine, but tip position appeared to be in the SVC, not caval atrial though. Anyway if anyone could share there thoughts or come up with some possibilities suggesting it is the PICC would be greatly appreciated.
Thanks sandi kishi
Hawaii
We have placed thousands of piccs and have never seen a hemothorax related to the insertion. How do they know it is blood? Was a thoracentesis done? We often place piccs in order to get cvc's out in a timely manner and I could see the possibility of a leak from the removal of a perqutaneous line but you said she had no other procedures so I guess that is ruled out. Vein erosion is pretty rare in an adult patient but if it was a left sided insertion with the tip pointing into the vessel wall as opposed to straight down in the low svc that risk increases significantly. Perhaps she needs a ct angio to see where the blood is leaking.
Let us know the outcome of this one?
Darilyn Cole, CRNI
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
Was the PICC used for high pressure injection for CT? If so, there could easily be tip whipping inside the vein to produce this outcome. In an animal lab, I have seen this whipping problem cause a complete laceration of the SVC. Also, tips placed higher in the SVC are known for tip migration to other vessels. Are you certain that the tip was in the SVC for the entire length of dwell or could it have migrated without your knowledge? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861