I am not aware of any publications, however this must be treated ASAP with referral to the IR for possible snare retrieval with a femorally inserted catheter under fluoroscopy. If this falls surgery may be required. The sooner the better because of the wire or catheter fragment becoming embedded in the heart or vessel wall from the normal thrombosis process.
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
Have you ever heard of placing a tourniquet on the arm?
We had an IR Doctor tells us not to recommend using a tourniquet, just to recommend sending to IR immediately for the femorally insert.
Cindy Hunchusky, BSN, RN, CRNI
The tourniquet idea is based on the hope that you can compress the vein fast enough to retain the wire in the peripheral vein. I am not aware of anyone reporting any data with the outcome of this technique, however I doubt that it would be very effective. You would need time to remove the drapes, reach, and tie the tourniquet. Then consider the fact that the basilic at venipuncture site and brachial veins are deep veins, not superficial veins, and very unlikely to be compressed by the tourniquet. Just my opinion, but I have doubts.
Robbin George RN VA-BC
I like this suggestion! I'm going to try this. Although your suggestion does not address what to do if the wire is lost, avoiding a lost wire works REAL good for me. Thanks!
To the one who lost a guide wrie while doing exchange on a PICC to a Midline, do you have a procedure how this is done the safest way? There is a way of doing exchange with using a guide-wire.
I have seen a PICC guidewire left in a person for a few weeks. She had a PICC inserted, apparently with difficulty, at a different hospital and was travelling back and forth from her home to the Cancer Clinic in our city. As the PICC was quite bothersome (was at ACF) they removed it and booked her to see me before next treatment.
New PICC inserted without any difficulty, wasn't a great x-ray, but okay for tip placement so off to the Ca Clinic with her. Something made me play with the x-ray and then quickly head to radiology for a rad to look closely at it. Sure enough, guidewire was going from about mid SVC through the heart. Pulled up the original x-ray from else-where and you could see the tip of the guidewire peeking out from behind the PICC tip in the SVC...kind of looked like a 2 tipped PICC. Quick call to the Ca Clinic to hold on to her (she lives about 3 hours away), in to angio for a Rad to snare the wire.
First, suggestion is to place tourniquet if you know right away it is still along the brachial area, but if you know it has gone into the heart, then complete bedrest til you get that patient to IR for retrieval of the wire and or, surgical consult involving a thoracic surgeon.
There is a safer way of doing an exchange without the use of a guidewire to eliminate this problem.
If you want to know, email me @[email protected]
My concern with using the tourniquet method is if the circulation becomes impaired and you release the tourniquet the flow of blood would increase causing the wire to migrate faster than if you just had the patient on bed rest until an IR team could retrieve the wire.
Linda Lembo CRNI
Ridgewood, New Jersey