50's y/o male came back to the hospital c/o abdominal pain. Lab tests showed elevated amylase and lipase. He had a PICC which was previously placed for about a weeks for home health ABX for colitis. He was admitted to floor. GI physician ordered abd CT with contrast, pancreatitis protocol. When contrast was injected, patient screamed in pain and holding onto the right side of the neck. His neck was swollen. A stat Xray of the area showed the PICC tip in the RIJ!!! US doppler showed ruptured RIJ!!! He was transferred back to the floor and had a surgery that night to repair the vessel.
OP or ER pts come in with a PICC, they need to have a CXR to confirm the tip.
I found out CT pancreatitis protocol contrast injection rate is 4 ml/sec = 14,400 ml/hr !!!!!