Robbin George RN VA-BC
I am wondering if this was caused by an infiltration of the PIV?
A PIV distal to a PICC site is always the last resort. Was the PICC placed in the basilic vein? Was the PIV on the basilic side or more likely in the cephalic vein? If the PIV was placed on the ulnar side of the arm, there is a great chance that it was infusing through the same vein where the PICC was located. Also, why was the PICC not working? If there is thrombosis in the vein around the PICC, and the PIV is on the ulnar side of the lower forearm, then infiltration at the PIV site is entirely possible. The reason is obstruction of fluid flow upstream leading to overflow of the fluid at the PIV puncture site. This is a well known cause of infiltration/extravasation injury. How long had the PICC been in place? Was there enough time for the puncture site to heal sufficiently? If not there could be some leakage from that site as well.
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