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Dawn1
unable to remove a picc

We have a patient who has had a picc in since 2005. It was ordered to be removed as therapy was complete. We were unable to remove it. We tried warm compresses twice. Only 20cm was successfully pulled. Catheter still had good blood return & flushed well. Patient c/o pain at insertion site when attempting to remove it. We sent her to Radiology. They were unable to remove it. Now she needs to have it surgically removed. Any suggestions?

Thanks,

Dawn Lentz RN, CRNI

despite intense teaching and providing the Bard patient care booklet, I had a patient whose line wouldnt come out and did as Dawn did. angio had to snake it out from the groin..and it was found to be in a knot!!!...seems the literature didn't tell him he couldnt chop wood!!!???

afruitloop
It would be interesting to
It would be interesting to doppler the extremity to see how much fibrin encapsulates the line....

Cheryl Kelley RN BSN, VA-BC

fizerjk
I have assisted in IR with
I have assisted in IR with the removal of a PICC line that was stuck after a fibrin sheath accordianed up around the PICC. At that time the cut the catheter and place a introducer over the PICC into the vessel separating it from the catheter. The PICC was then removed without difficulty. No adverse events noted after removal. I have seen ultrasound images of fibrin sheaths remaining in the vessel after removal of CVC devices.

Jeffery Fizer RN, BSN

lynncrni
After about 2 weeks of

After about 2 weeks of dwell, the catheter is now encapsulated with the fibrin + smooth muscle + collagen. So it is a very stable structure. With time, I think this would only become a stronger structure. It sounds as if there is a complete connection between the catheter and vein wall and the collateral circulation had taken up the blood flow. I would be very interested in what the vein looked like during this surgical removal. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

gretchen
I thought you are only
I thought you are only supposed to keep a PICC in for UP TO one year....
Arlete Mazzini ...
[quote=gretchen]I thought
[quote=gretchen]I thought you are only supposed to keep a PICC in for UP TO one year....[/quote]
lynncrni
No, there are no

No, there are no recommendations or guidelines that state any time frame for PICC dwell. CDC guidelines states the optimal dwell time for all CVCs including PICCs is unknown. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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