We started doing PICC lines in Dec 2007. Early on we had a pt the developed a chest wall hematoma 24 hours after the insertion of the PICC line. I believe this happened in late JAnuary.Â A dye study done at the time the hematome developed showed that the PICC line was patent and in proper postion.
A few weeks later the doctor of the above patient was appoached by for for a PICC line order for a ptaient she had. This patient was in with sepsis related to her gallbaldder. I called on a Friday as the patient was on 3 different antibotics ans was not having surgery until Monday.
Â The physician refused to allow me to put a PICC line in. She went on to tell me how the PICC line had cause a chest wall hematoma on her other patient. I explained to her that I really didn't think the PICC line had casued the chest wall hemotoma but that if it had that it was the only incident or issue we had and that we had placed over 100 PICC lines and had not had a problem.
Anyway she went on to accuse me of "brushing it under the carpet". The radiologist called and spoke to the doctor and told her that he too felt the PICC line had not cause the hematoma. He went on to say that IF it had beeb because of the PICC line that it would have happened whether it was a PICC nurse or radiologist.
About 2 weeks ago, the doctor was approached about putting a PICCC line in another patient. The patient was on a dobutamine drip. The doctor wrote "PICC line to be inserted by IR". The order was cancelled a short time later by cardiology becasue the patinet was having a pacemaker placed the next day. The cardiologist did not want to risk an infection the day before the pacer was placed.
Fast forward to today same patient same doctor. But cardiologist orders PICC line. By the time we were able to get to the floor, the prinmary doctor has called and stated the if Cardiology wanted PICC line it was to be placed by radiology. Now this poor man had been stuck poked and proded for over 2 weeks. An it is my understanding from what I have read the Dobutamine with a pH average of 3.5 should not be run in a pheripheral IV.
So the point to my rambling is
1) Does anyone have any documentation of a chest wall bleed 24hours post PICC insertion? Was the bleed thought to be relates to PICC linsertion?
2) How do you deal with such a physician?
Thanks in advance.
Rhonda Wojtas, RN