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mary ferris
Difficulty removing
We had a picc that we had A LOT OF DIFFICULTY REMOVING  HAS THIS HAPPEN TO OTHERS AND WHAT ARE THEY DOING. Any published information on removing difficult PICC  lines
Lots of reports of this and
Lots of reports of this and several publications that discuss it and it is a part of all PICC Insertion Courses. Do not ever attempt to force removal as this will only exacerbate the problem and risk breaking the catheter. The smooth muscle in the vein wall can hold a contract for extended periods of time with very little energy. And it only takes a small amount of stimulation to cause the contraction. Most of the time the cause is venous spasm, however it could be thrombosis. When you encounter this problem, stop immediately. Distract the patient and encourage deep breathing. Try again in a few minutes. If there is still a problem, put a dressing on the catheter and keep the extremity covered, warm and dry. Encourage the patient to drink warm liquids and try again in a few hours. It is quite possible for this to require up to 12 to 24 hours for the vein to relax. If this does not work, sublingual nitroglyerin may work. If the cause is thrombosis, a tPA infusion from a distal vein may be required. Time and patience is your best choice of treatment. 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

Gwen Irwin
We have had patients that

We have had patients that are highly anxious and seen them more likely to react to PICC removal.  I agree with Lynn.  Another factor that helps is having a calm nurse.  Be aware of your own stress reaction and reassure the patient that this occurs with some patients.

We have had patients that actually felt the "release" of the vein and tell us that you can take it out now. 

Difficulty with removal seems to happen rarely now.

Gwen Irwin

Wendy Erickson RN
You can also get the
You can also get the situation where the fibrin sheath surrounding the catheter "catches" on the PICC and telescopes down the catheter as it is withdrawn until it is in a smaller vessel and you can no longer withdraw any more.  You will feel a lump or mass above the insertion site and typically you will have removed almost all of the catheter.  DO NOT ATTEMPT TO REMOVE ANY FURTHER or you run the risk of snapping the line.  A surgeon needs to be called to perform a cutdown to remove the fibrin mass and remaining catheter.  We have had this occur periodically, and I train nurses to always check for that mass to help them determine whether it is venous spasm vs fibrin mass.

Wendy Erickson RN
Eau Claire WI

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