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piccteam1
Problems with copper stylet in Power Piccs

This past month we have had tremendous difficulty with BARD power piccs and groshong catheters. The copper stylet (for the sherlock catheters) gets stuck in the picc line and we either can't remove it or we remove it with tremendous difficulty, causing the catheter to stretch and bunch up (i.e. when we pull the stylet back to cut the picc prior to insertion). One picc line had to be removed because we couldn't get the stylet out of the catheter. This has happened with several different lot numbers. Is anyone else having issues with these BARD picc lines?  Thank you

Saharris
Wire vs. Clinician

First let me say I have no affiliation with any PICC company. Second I am a little confused by your question because you say it happens before insertion( i.e when trimming PICC) and then you say a PICC had to be removed so I am assuming we have two different things going on here. The first is most likely inadequate flushing if it happens before insertion. Flushing before wire manipulation makes everything nice and slippery. The second is a little more subtle but I will take a crack at it. I would hazard a guess that post insertion if the wire is stuck at some point the nurse unscrewed the Sherlock wire and backed it off a bit to assist with insertion, against the IFU's and thus off label but many nurses do this. With any stiffening wire if you back it off and then insert it you really need to feel what's going on. For instance you are inserting and all is well, then you meet some resistance at the brachiocephalic junction and you unscrew the wire and back it off a few inches. Then you advance the now floppier PICC and it loops back on itself. Now the nurse is a bit heavy handed and forces the wire back in. It kinks in the PICC and voila, a stuck wire and or catheter. This can happen with any wire and any catheter because the nurse was not paying attention to all the signals the wire was giving her/him. I would bet a drink that in the instances where the nurse had difficulty removing the wire when it did come out it was really botched up. If you make the clinical decision to go off label a good rule is when there is resistance putting the wire back in always back the PICC up to the wire and never force the wire in. As a inserting clinician when something goes wrong for me I always want to blame the equipment as that is easier on my ego but the majority(not all)of the time I have to look at my technique for the real answer!

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

Alma Kooistra
I have also experienced some

I have also experienced some difficulty pulling the stylet back recently........and this is pre-insertion with the PICC flooded with saline.  My solution has been to lay the PICC flat on the sterile surface while I pull the stylet back.  Generally I have always looped the tip of the PICC back and held it with the desired length marking next to the hub while I pull the stylet back to trim the catheter.  The wire now seems 'sticky' inside the PICC and will only pull back if the PICC is essentially straight/flat on the surface.  I have not had any issues pulling the stylet back once the PICC is inserted. 

Alma Kooistra CRNI

sue verbella
difficult stylet removal

I have also noticed recently, the difficulty with stylet removal. I agree with ensuring the catheter is comletely straight when flushing to lubricate the catheter prior to withdrawing, triming, and then readvancing the stylet. I haven't manipulated the stylet during insertion, but have had difficulty withdrawal the stylet once tip verification is obtained.

Dan Juckette
Disclosure: I have worked as

Disclosure: I have worked as a Clinical Educator for Bard Access Systems.

I have experienced this problem with a single lot of 6FR triple-lumen catheters. The first time it happened was when withdrawing the styllette for line trimming. After laying flat, I was able, with substantial force, to the stylette for trimming but it was difficult to re-insert after trimming. I ultimately placed that PICC and the patient completed therapy without further difficulty. When I happened a second time, I notified Bard and returned the remainder of the lot to Bard's Field Assurance engineers for replacement. I have been using these catheters for over three years and last month was the only time I have experienced that problem. Subsequent lots have not had "sticky wires. I experienced something similar with Groshong PICCs many years ago while doing a PICC contract service in Phoenix. Those trays were stored in non-climate controled storage areas and then left in hot vehicles in the Phoenix summer heat until needed. The catheters were melted onto the wires. The problem went away with climate controls. I think there could be a problem in the transportation chain that is exposing some of these trays to excessive heat. I doubt anyone will send out anouncements when they find out what the issue is, but if other people are experiencing it as well ,then I believe this is a legitimate quality issue and that it will be solved.

Daniel Juckette RN, CCRN, VA-BC

Sara
Stuck wires

Have been using groshong since early 90's and now using all their lines.  Many stuck wires during the past few months.  We tried to determine the lot numbers and have those replaced.  Our sales rep assured us that no one else has had any problems and she has tended to be ignoring us so have taken it further.  Just had trouble with a power picc.  We try to check before placing the picc.  I once opened 3 kits to get one that wasn't stuck...and yes they were all very well preflushed.   I have been placing piccs since 1989 and this is the first time that I have felt that Bard has ignored our hospital requests.  Just talked to our director and she assures me that she is looking into a whole new system of piccs, ultrasound, and the new locators (no xray).  Unfortunate since I think we are the largest Bard acount in northern IN.  All  the picc nurses (13) loved the bard products but we are ready for a change.

 Any suggestions as which company could meet our needs?  

 

 

Thank you,

Sara

 See you down the trail...may the good Lord take a liking to you.

Laura M.
BARD has a sticky wire

BARD has a sticky wire problem and they are  aware of it.  We had all of our current stock removed and replaced with the ECG catheter tray until they can figure out the problem.

Laura McRae, RN, BSN, CRNI

VAT RN
We have been experiencing

We have been experiencing this exact problem. We too have contacted our rep and saved the wires. Here's the wierd part, if we open a second kit and use that wire....no problems. It makes me think it is the wire not the PICC. We even looked at lot #'s. Two wires from the same lot, one "sticky" one not. Each time the line was well flushed.
 

I have no idea what the climate control is like from our warehouse in Oklahoma, or the transport trucks to Kansas.

I would just keep contacting your rep anytime you have a problem, or find out who their boss is.....

 

DCrni
I have had two situations

I have had two situations with power piccs  lately where the stylet would not remove until I pulled the catheter back 3-4 cm and then it pulled out normally.  I believed this was attributed to a tight turn somewhere along the course of the vein.  Now I have to rethink that.   These were sapiens wires which are definitely different than the regular sherlock wire.  

 

Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA

 

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