When removing a PICCÂ if you run into resistance, is it still appropriate to place tension on the catheter, redress with sterile dressing and wait 4 hours then retry removing ?
Although some recommended traction, this has never been the best way to manage a stuck PICC. The reason is the tunica media or the layer of smooth muscle inside the vein wall. It requires very little stimulation to cause contraction and can hold that contraction for very long periods with very little energy. So traction makes the problem worse -always has. So simple tape without traction, put a dressing on it, apply heat, have patient drink warm liquids and wait. A tincture of time is probably all that is needed. But never use traction!! Lynn
As Lynn reports, a tincture of time is always best, and it's usually a matter of waiting out the venospasm. Sometimes a PICC is stuck by the fibrin sheath and you can actually feel a lump where it has "accordianed" under the skin. We have had success freeing PICCs stuck with fibrin by instilling a dose of TPA. This is an off-label application, of course. Hope this helps. Nancy Costa
I always cringe to think of where the fibrin sheath goes with the withdrawal of a central line? Does it stay attached to the vein wall? Does is float off and lodge somewhere? I have not been able to find the answer.
The fibrin sheath is stripped off and is destroyed by the body. I have never seen any published information about the sheath causing a problem for the patient. The other issue is the presence of a complete clot on top of the fibrin sheath. A complete clot can easily become a pulmonary emboli when a catheter is removed.
Although some recommended traction, this has never been the best way to manage a stuck PICC. The reason is the tunica media or the layer of smooth muscle inside the vein wall. It requires very little stimulation to cause contraction and can hold that contraction for very long periods with very little energy. So traction makes the problem worse -always has. So simple tape without traction, put a dressing on it, apply heat, have patient drink warm liquids and wait. A tincture of time is probably all that is needed. But never use traction!! Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Hi Lynn- from Omaha NE,
I always cringe to think of where the fibrin sheath goes with the withdrawal of a central line? Does it stay attached to the vein wall? Does is float off and lodge somewhere? I have not been able to find the answer.
Thanks,
Cindy Kahnk
The fibrin sheath is stripped off and is destroyed by the body. I have never seen any published information about the sheath causing a problem for the patient. The other issue is the presence of a complete clot on top of the fibrin sheath. A complete clot can easily become a pulmonary emboli when a catheter is removed.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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