The renal doctors ordered a PICC insertion on a pt. admitted from the E. R who had an MI and hypotension. Assessment indicated he had a central line catheter 2 years ago on the left side and currently had a fistula on the left side also. INR was 1.3. No history of thrombus for 2 years. Accessed his right basillic vein very easily and catheter advanced easily but was not able to aspirate blood unless it was pulled back 5-6 cm. During the procedure the pt. began bleeding quite heavily around the site and his upper arm was bruising quickly and swelling. TLS indicated the catheter was going across his chest and was not going down SVC. Bleeding increased dramatically and the heparin drip had been stopped immediately prior to the procedure. I pulled the PICC out, placed pressure on the site and applied ice pack to his arm. NO further attempts were made and stat lab work was ordered to determine his clotting time. What do you think happened and what would have been the best practice to use? After the procedure the daughter came to the hospital and said the pt. had a port in his right chest 2 years ago and it was removed due to infection. That information was not available prior to the insertion.