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Robin Wanous-Wi...
Edema distal to PICC

Any thoughts as to what the problem might be?

 PICC inserted 5/1/07 for administration of Tigecycline every 12 hours for 10 days and 0.9% NaCl at 50ml/hr.  Insertion was done at hospital so I cannot comment on any possible insertion problems.   On 5/7/07 nursing home nurse reports a pink area distal to the insertion site and distal to the dressing.  No redness, warmth, or drainage at the insertion site, under the transparent dressing.  Brisk blood return upon aspiration.  Flushes without resistance.  Area was warm packed.  On 5/8/07 condition is unchanged.  On 5/9/07 nurse reports swelling below the insertion site from fingers to antecubital fossa.  Skin is pink, not red, shiny and taught.  No warmth and no reported pain.  No leaking at the infusion site.  PICC still has brisk blood return.

anna liang
sounds like a DVT case.
sounds like a DVT case.
I agree with Lana.  The

I agree with Lana.  The first sign of thrombus, in my experience, is swelling of the

fingers and hand with progression up the arm.

T. Nauman RN, CRNI

lynncrni
I agree with the DVT. The

I agree with the DVT. The original message did not state the size of the PICC nor the vein used for insertion. This is a nursing home patient, but we don't know the age - could be dealing with smaller veins or the possibility of fluid volume deficit. 

Within the first 24 to 72 hours after a PICC is placed, there can be slight edema distal to the insertion site. This is usually considered to be the result of the PICC filling the space in the vein lumen where blood was previously flowing. Now the blood must find collateral veins to make its way back to the heart. This can take some time, thus resulting in transient edema that will resolve easily. This is a worsening situation not responding to the usual treatment for phlebitis. A dye study through the catheter will not reveal the problem. You will need an ultrasound to diagnose the DVT. Lynn 

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kenwthomas
I echo the suspicion of DVT
I echo the suspicion of DVT first. But, as I do only nursing home patients in my practice, I have seen this phenomena often enough to deduce that, in most of the cases I saw personally, the venous return system was very compromised in these patients. Once we took their only large return vein for a line, the congestion of blood return coupled with compromised cardiac status already produced this result. Elevation, warm compresses, and sometimes I'd swap out the 5 Fr for a 4 or 3 fr line to help with blood flow.  Ken
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