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anna liang
charting: 'hit a nerve'?
how do you chart if you suspect that you might have hit a nerve?
We usually chart more of the

We usually chart more of the signs and symptoms.  ie:  Pt c/o tingling in hand after IV attempt radiating to elbow.

I would chart the signs and
I would chart the signs and symptoms - anything the patient complained of and anything you observed. Plus you must also chart your intervention. When a patient complains of tingling, numbness, electrical shock-type pain, the intervention should be to immediately remove the catheter and stylet/needle. If you do not include the removal, your lack of documented action could be a later problem if there is a lawsuit. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

anna liang
Thank you. When I read the
Thank you.

When I read the 'reporting standards for central venous access' & 'QI guidelines for central venous access', I could not find any word related to nerve (complication).

any insight?
Considering the number of
Considering the number of midlines I place in the medial basilic, if the patient was to mention that he or she felt tingling in the hand on the insertion process, and I have a positive blood return, threading without obstruction, and confirmed blood return and easy flush, would I still be obligated to pull the mid or picc out because of the patient's comment?
My thought is that if the

My thought is that if the symptoms subside after the procedure, then it would be no problem to leave the line in place.  Please correct me if i am wrong.

Related question:  My partner placed a line last week on a patient who did not complain during the procedure. After line was in place, patient stated that she had slight numbness in thumb and index finger. On questioning, she admitted to a slight shocky feeling during insertion of needle which she did not complain about during the procedure.  We left it in place to see if symptoms would subside. (sometimes patients feel some numbness just related to positioning during procedure -hope i'm not wrong on this too). Anyway, the next day she was checked and fine motor co-ordination of her thumb and index finger was slightly impaired. The patient was not concerned about this but my partner was. The line was left in (whoops). I checked with the unit today when I learned about this and heard that there were no complaints from the patient (though I think that she would not complain so don't know if it still exists). The line is coming out as she is going to be discharged.  I am going to follow-up to see if the symptoms are still there and if so, if they are still there when the line is pulled. I realize the line should have been pulled with the continued symptoms but also am wanting to know what the treatment would be, if there is any way to treat this. That is, if she still has symptoms once the line is pulled.

Just wanting to be sure I
Just wanting to be sure I understand correctly.  If a patient c/o electric shock-type pain during insertion, the procedure should be aborted at that point, or should the patient's symptoms be evaluated after the procedure and the line pulled if symptoms persist?
rivka livni
What I learned from

What I learned from experience is that if the patient c/o pain, whether it is a shock, tingling, numbness, "funny feeling" or what ever, I do not leave the line in, or if it happens during insertion, I abort the site and go to another site or the other arm. Any pain other then site soreness for 24 hours is unacceptible.

I found that nerve pain do not really get resolved if I left the source of the irritant, which is the line, in.

The only pain that gets resolved, usually within 24 hours, is only the soreness caused by  a very difficult case of isolating a suitable vein with multiple sticks.

I am seeing more and more

I am seeing more and more legal cases on PICCs and nerve injuries. The cases are both from attempts and from lines left in place. If you make an attempt where the patient experiences an electric type shock, pain running down the arm to the fingers or numbness the standard of care says you should stop, pull completely out and document the experience with your action. Leaving a PICC in place and monitoring the numbness or pain is simply allowing more injury to occur and keeping you open to huge liability. It is not normal for a patient to experience pain after placement of a PICC, consider this a complication and discontinue the line. Pain after placement is either through/impenging on a nerve or placement in an artery.

Just my two cents

Nancy L. Moureau, BSN, CRNI                                                                           PICC Excellence, Inc                                                                                           1-888-714-1952                                                                  [email protected]


Nancy L. Moureau, BSN, CRNI, CPUI, VA-BC

PICC Excellence, Inc


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