Placed a PICC. Patient stated had slight tingling when needle was place and when needle was withdrawn. Then resolved. No symptoms with introducer or PICC insertion. Left the picc in. When i next saw him, a day or 2 later. He had a heating pad that was ordered by the doc. I assumed possible phlebitis but when I visited him he said he had pain down the arm whenever he moved it. I pulled the line and placed a new one. Symptoms resolved right away. Then later i was speaking to an expert who said that it was "nerve irritation"(i think) and said that antiinflammatory could have been tried. What say you?
Complaints of tingling, shock-like pain, "pins and needles", and pain running up or down the arm are all signs of nerve damage. This always requires that you immediately remove the needle and choose another site for whatever catheter you are placing. If left in place, any trauma can progress to a permanent, life-long pain syndrome first known as reflex sympathetic dystrophy, now known as complex regional pain syndrome. This is the cause of numerous lawsuits. Nerve damage from any type of venipuncture and catheter insertion must be taken very seriously. Always abort the procedure immediately and find another site. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
thankyou, Lynn for all your answers to my questions (to my delight). I know you have talked about the nerve damage thing before...now I am really sold.
sharon
Lynn,
I checked your blog and did an advanced serch on this site because I know you have referred to Reflex Sympathetic Dystrophy before...perhaps even to an article you have written. Other than this posting the searches turned up nothing. I would appreciate references from you about this subject and how it relates it to IV therapy.
Thank you,
Linda Motley
I will put this on my list to add to my blog. In the meantime, check the AVA website to see if you can order a presentation on tape from the 2006 meeting on nerve damage from catheter insertion. Thanks, Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I have always removed the needle or the PICC, if it gets that far, before the pt complains, and gone to another site. I had a pt. a while back that was complaining of s/s of nerve involvement. One of our nephrologists who frequently places dialysis catheters advised not to pull it, but to wait for several hours until the Xylocaine had time to wear off. I was very uncomfortable with this but gave it two hours hesitantly. His comment was that sometimes you inadvertantly give a nerve block which also can cause these s/s. Well after the two hours and checking w/pt frequently, the s/s were still there, I d/c'd the line. His s/s immediately resolved once the PICC was removed! I would not risk causing potential permanent damage.
Cindy Hunchusky, BSN, RN, CRNI
I agree with immediate removal. If the patient complains of any of these symptoms, the site is abandoned and another insertion site is considered.
Gwen Irwin
Austin, Texas