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How NOT to place a PICC line

After a prolonged,unsuccessful bedside PICC attempt that apparently included an arterial puncture,the patient was sent to radiology for placement. The nursing notes were vague,only that 2 nurses tried for 2 hours before the patient was sent to IR. She had a pacemaker in the left,just as an aside.

Picture 1a and 3a show the extensive ecchymosis that resulted from the vessel injuries and prolonged tourniquet time. These were taken a few days after the procedures,and both the patient and staff remarked how much better the arm looked and how much less swelling there was in the hand and fingers,which were also black and blue.

"Does anything hurt?" I asked and had her indicate where she hurt. With the stump of her her right arm,she pointed to the most painful area as best she could since she'd had her right hand amputated in the past. See 2a.

mary ann ferrannini
 I have never seen such
 I have never seen such ugliness from a PICC insertion. Someone failed to do what was in the best interest of the patient. It looks like after hitting the artery they either reapplied the tourniquet too soon and/or were unsuccessful in applying pressure. That does not even account for all the damage they did to the veins. The patient would be lucky not to get a compartment syndrome !!!!!
Timothy Royer B...
David These are wonderful


These are wonderful "how not to place a PICC pictures.  Can they be used for educational purposes for when I teach.

Email [email protected]

Great pics, here's what I

Great pics,

here's what I found on youtube after searching for PICCLINE INSERTION, anybody have any comment for this "DOCTOR"


One thing he's got though is a great bedside manner...

Robbin George
See how many ways he breaks

See how many ways he breaks sterile technique--Starting with NO head cover--NO patient body drape--NO probe cover--He touches the US with sterile gloves and places the uncovered probe on the ??"Sterile"?? field--He inserts the needle through unsterile gel then drapes the arm and then has his ??"Nurse"?? numb the skin and apply a few dabs of CHG Prep (I did not understand the logic of this entire sequence)--The patient is touching the drape and at one point moves her hair off the ??"Sterile"?? field--I'm sure there are more and in fact you can find many more breaks in technique when you watch the YouTube video entitled "PICC Line Dressing Change"--See the clinician touch the sterile tray with unsterile gloves--Place sterile supplies on unsterile field--Change to sterile gloves without cleaning hands inbetween and then he proceeds to remove the OLD dressing with sterile gloves


Robbin George RN VA-BC

Unfortunately, I too have

Unfortunately, I too have seen this similar scenario once or twice before. It is awful what some of the patients go through just for reliable IV access.

One comment I have though on "Badarm3a" that may cause problems with flow or clotting: see the way the external portion of the PICC crosses over the AC? When patients bends that arm, it will cause kinking in the tubing. I would reposition that so it sorta loops over to the side and apply to Statlock there. The focus so when the patient bends the arm the tubing won't kink. I've seen so many problems with the way some of the nurses are positioning & dressing these lines and I have to educate, educate, times so frustrating when they call me to de-clot their PICC!   Also, the Biopatch isn't on properly.

Sorry for the soapbox!

 Raquel M. Hoag, CRNI

Raquel M. Hoag, BSN, RN, PHN, VA-BC

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