I am questioning the placement of a peripheral IV below a PICC and am looking for others input.
A patient came into the ECC with a 4 FR. Groshong PICC that we had placed 6 weeks ago for abx. therapy. The patient has one arm that can be used for IV therapy and the physician ordered a CT of the chest with contrast. The IV nurse placed a #22 protective plus (short peripheral catheter) in the antecubital basilic vein. The PICC was located in the basilic vein superior to this short catheter by about 4 1/2". The patient received the contrast by power injection. The next day when I was checking the PICC I found the short peripheral catheter, removed it and then the discussion ensued. There was no objective findings to indicate that an extravasation had occurred.
As a side note, the nurse did not relay her findings regarding the only available vein and potential for extravasation from the PICC insertion site to the physician because she felt due to the length of time the PICC had been in place it would have created a seal around it.
Thoughts? Evidence?
Theoretically, placing a PIV in the same vein that close to a PICC site is not a good idea. But I can not quote a specific research study to support that argument. Even if there was a "seal" around the PICC insertion site, it is quite possible for the high pressure from the injector to break that seal and lead to extravasation. If there was not the option of using the opposite arm, my thoughts would have lead me to the cephalic vein in the AC rather than the basilic vein where the PICC was.
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
A power injectable PICC would have prevented this, right?
I am confused. I don't think that a "seal" occurs. I have never seen evidence that indicates that a seal occurs for a PICC site. I agree with Lynn to choose another vein path, such as the cephalic.
Did an extravasation occur from the peripheral IV for the contrast in this case?
My next question is using a 22 gauge catheter for power injection. Was the quality of the exam good? We have so many problems with the CT RTs not using anything less than a 20 gauge (they really want 18 gauge in large vein). I am tired of arguing with them, but I have not given up.