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Tracy Snashall
hives post PICC insertion

I recently experienced a reaction post PICC insertion of a 47 year old female who approx 1 minute post insertion, c/o itching and developed hives head to toe. The PICC was in, dressing on, and line flushed with normal saline.  The MD ordered Benedryl 50mg IV and within 5-10 minutes, hives were gone, and no further reaction noted.  Any comments about the cause of this ??

Idiopathic anaphylactic

Idiopathic anaphylactic reaction, anaphylactoid reaction, mast cell activation syndrome - all names that have been applied to this. Several years ago, I created a poster on this that was displayed at INS and AVA. I don't have an electronic copy. 

Basically, the theory of what has happened is that the advancement of the catheter created a physical stimulation of the mast cell, which are located very close to veins and arteries in the subcutaneous tissue at the rate of about 10,000 per cubic millimeter. When stimulated they dump histamine into the bloodstream producing the clinical signs you saw. Red man syndrome from Vancomycin infusion is the same thing only there is a chemical mechanism that stimulates the mast cell.

If severe, Benadryl is not the drug of choice to treat this problem because histamine has already attached to the histamine receptors. This means an antihistamine may not be effective. Epinephrine may be required. 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

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