Any thoughts as to what the problem might be?
 PICC inserted 5/1/07 for administration of Tigecycline every 12 hours for 10 days and 0.9% NaCl at 50ml/hr.  Insertion was done at hospital so I cannot comment on any possible insertion problems.  On 5/7/07 nursing home nurse reports a pink area distal to the insertion site and distal to the dressing. No redness, warmth, or drainage at the insertion site, under the transparent dressing. Brisk blood return upon aspiration. Flushes without resistance. Area was warm packed. On 5/8/07 condition is unchanged. On 5/9/07 nurse reports swelling below the insertion site from fingers to antecubital fossa. Skin is pink, not red, shiny and taught. No warmth and no reported pain. No leaking at the infusion site. PICC still has brisk blood return.
I agree with Lana. The first sign of thrombus, in my experience, is swelling of the
fingers and hand with progression up the arm.
T. Nauman RN, CRNI
I agree with the DVT. The original message did not state the size of the PICC nor the vein used for insertion. This is a nursing home patient, but we don't know the age - could be dealing with smaller veins or the possibility of fluid volume deficit.
Within the first 24 to 72 hours after a PICC is placed, there can be slight edema distal to the insertion site. This is usually considered to be the result of the PICC filling the space in the vein lumen where blood was previously flowing. Now the blood must find collateral veins to make its way back to the heart. This can take some time, thus resulting in transient edema that will resolve easily. This is a worsening situation not responding to the usual treatment for phlebitis. A dye study through the catheter will not reveal the problem. You will need an ultrasound to diagnose the DVT. 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