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Angela Williams
So you think you had a bad day.....

caused a patient to have "nurse blue" with PICC insertion...PICC insertion perfect, dressing on, pt says "Feel funny"and "cant get my breath"PICC appeared on Sherlock to be perfectly positioned...but I quickly pulled back suspecting atrial dysrhythmia, patient desating O2 sat 64%, patient now sitting straight up in distress, I pulled PICC completely out, nurse blue, non-rebreather, etc, etc, wont do her at the bedside again...I put in about 500 PICC's a year, have seem odd rhythms that usually resolve when PICC pulled back...not this time. Then later sticking patient for PICC with angiocath, attempted to pass wire, wouldnt pass easily with minimal manipulation, stuck again, catheter in vein, blood dripping, guidewire again passed, unable to advance ,arm repositioned, no luck, started to remove wire..wire came out,but unraveling...had to send to IR to remove the wrapping as wire came out,but wrapping on wire still in arm..never seen this before unless wire was accidently cut..this wire did not come into contact with any sharps , so I've notified company with lot number, etc,etc....other 5 PICC's went great, but these two caused me to fill out more incident reports today than I've done in two years...Please tell me others have these kinda nightmare days!

lynncrni
Did your patient have any

Did your patient have any other signs and symptoms before you removed the PICC? Any swollen tongue or throat, hives, itching, abdominal pain, anything? Why did you decide to pull the PICC? If you needed to give any IV meds, this would have been the best route and finding another vein may have been very difficult. I suspect this may have been another example of mast cell activation syndrome that has been seen with midlines and PICCs for many years. Lynn

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

Angela Williams
Her c/o was "feel funny" and

Her c/o was "feel funny" and SOA..after event over, she said she felt heart skip...I started at onset of symptons with just pulling PICC back a few cms., but with her increasing anxiety and struggling to sit up to breathe, PICC out probably 20cm so pulled out rest of way, held pressure while getting resp situation under control and EKG being done....She did have a peripheral site in place...I have heard of mast cell activation syndrome..guess I need to educate myself on this ..Thanks for you input

Angie

Angela Williams RN BSN CRNI

Clark Memorial Hospital

Jeffersonville IN

tmhop
Here is a link about

Here is a link about mastocytosis that includes some information on Mast Cell Activation Syndrome/Disorder

http://www.tmsforacure.org/mastocytosis.shtml

lynncrni
Very good site, thanks. This

Very good site, thanks. This site did not include other things that we do that can trigger mast cell activation syndrome. Red man syndrome from vancomycin is a form of MCAS. Many other drugs can trigger it such as ACE inhibitors and morphine. Also physical trauma such as the advancement of a catheter is also thought to trigger it. This is derived from the knowledge of mast cell physiology and these catheter-insertion events presenting with similar signs and symptoms. A common nursing pathophysiology textbook listed physical trauma, chemical triggers, and activation of complement proteins as the non-immunologic causes of MCAS, also called idiopathic anaphylaxis or anaphylactoid reactions. Activation of IgE is the immunologic cause and the true allergic reaction or anaphylactic event. About 15 years ago, I did a poster on this at both INS and AVA. Lynn

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

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