Our PICC team places more than 220 PICCs a month at bedside using ultrasound guidance exclusively. We have had two unintended arterial punctures as a result of PICC attempts in the last month (very rare for this team). One of the PICC attempts was unsuccessful as the nurse was unable to advance the PICC past the patient's shoulder, so it was removed, and there was no indication that the PICC was in an artery. The arm began to swell as soon as the PICC was removed and the nurse called for assistance and a compression wrap was applied, arm elevated, evaluated by the unit NP, intact motor and sensory monitored, and labs monitored. Patient and family were informed. The vascular surgery fellow believed the swelling was "almost certainly" of arterial origin secondary to the PICC attempt.
I have been asked to write a guideline for care and assessment post-removal of inadvertently placed arterial PICCs. Is anyone aware of an article which highlights this? Does anyone have an exisitng guideline they would be willing to share?
Thanks much-
Andrew Mackler, RN, VA-BC
BIDMC, Boston, MA
In my years of doing PICCs I have punctured an artery or two. I might have not even suspected it was the artery until I placed the introducer and pulled out the inner lumen to pass the PICC line. The amount of blood return and force behind it is definitely noticeable, as well as even the backflow of blood when you cannulate the vein with the original needle makes me suspicious when it flows out quicker and is brighter in color.
I have never even passed the PICC line itself in the artery due to such a noticeable blood return as arterial. I promptly hold pressure and remove the introducer and stop all proceedings until I have held pressure for approx 5 minutes on the site and monitor it for swelling. I have had no further consequences after the fact. People get their arteries stuck all the time for ABGs,. Follow the same protocol for removal of the needle from the site of an arterial stick.
considering all this I wonder if it was an artery , or maybe just bleeding from the vein.
Gina Ward R.N., VA-BC
It has happened once or twice but as previously stated, the amount of blood and rapid flow is our clear indicator that we are in the wrong vessel. When you write your protocal use the guidelines from Respiratory for ABG's in combination with your Interventional Labs, they perform arterial catheterizations several times daily.