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adverse reactions post PICC insertion


I was wondering if any of the PICC nurses out there ever experienced this situation:


Pt requiring a PICC for vancomycin and other IV meds.  Has extensive cardiac history, and was requiring IV antibiotics for sepsis due to an infected prosthetic valve.

PICC placed in the right basilic vein with no complications.  No difficulty with cannulation, threading or advancing tip of catheter (appeared in good position with the tip locator).  While waiting for chest xray to be taken, pt started to complain of back pain, in a very short period of time she experienced SEVERE back pain.  The patients nurse was present in the room and stated that the patient never complained of this back pain any time during this admission.  PICC was removed immediately and back pain resolved after a few minutes.  Unfortunately xray not obtained before PICC removed.  I was not going to wait for xray while patient was in severe pain.   MD notified.

Next day PICC was attempted by another PICC nurse in the opposite arm.  She experienced the exact same symptoms, she as well removed the PICC before xray could be obtained, and the symptoms resolved once PICC removed.  The patient was referred to Interventional Radiology for placement.

We ran into the patient a few days later and I asked her if the radiologist placed the PICC, she said yes, but commented that they had ran into the same experience that we did with the back pain.  I asked her what they did and she said they removed it and reinserted again with less back pain which eventually resolved.

I spoke to the Head of Interventional radiology regarding these incidences and he was quite stumped.  He thought maybe if the tip advanced in the azygos vein? but he later said that would be highly unlikely due to the fact that three diffrerent inserters expereinced the same symptoms post insertion and what would the likelihood be that each one could have the tip terminate in azygos?  he also said that the veins do not have nerves so he did not understand.  Others thought maybe measurement was too deep, but he thought that would be strange as well, since three different inserters measuring deep?  Anyway, if anyone has ever experienced this type of incidence, I would really be interested to find out what was causing the BACK PAIN!!!

My next step was to contact cardiothoracic surgery to find out if they had experienced this with pacemaker placments, since they are advancing those leads deep in the RA.

Thanks Sandi Kishi







Wendy Erickson RN
Any chance this could be

Any chance this could be muscle spasm from laying flat with arm extended?  The fact that it occurs after she has been in the same position for awhile might be the issue.  I experienced severe muscle spasms in my back post op due to the positioning of my arms at 90 degrees.  For my next surgery they placed them at 45 degrees and I had no trouble.

Wendy Erickson RN
Eau Claire WI

  Thanks Wendy, I spoke to


Thanks Wendy, I spoke to our cardiologist who places pacemakers and ICD's and he could only hypothesize azygous vein.  He stated with patients with extensive heart surgeries, the anatomy of the heart/vessels may not be the norm.  But your hypothesis is a possibility as well.  Thanks again for responding.


Sandi Kishi


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