Hi, has anyone else experienced the 5FR Powerpicc splitting approx 5 cm below the connector whilst flushing or infusing? We just had a bad extravasation of oxaliplatin - the line had split below the insertion site, in the vein. It's not possible that it could have been damaged as it was internal. This is the fourth event since I started using them about a year ago (but fortunately the others weren't chemo). It seems like there is a problem!
Have you exceeded the recommended number of CTs through each PICC? Is this a slit along the length of the catheter? If so, this is usually due to high pressure. If it is a slit around the circumference, that is usually related to other mechanical damage such as applying a hemostat to the catheter, etc. Both types of damage can occur inside and outside of the vein. Is there a blood return upon aspiration? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynn
It's a slit around the circumference. Yes, blood did retun on aspiratation. None of the PICCs had been used for CT. I will check whether any of them had had a tourniquet or BP cuff used on them but this is not our practice so I very much doubt it. It's very worrying! I'm wondering whether I should not use any more and get some emergency stock in from another manufacturer.
I don't think a tourniquet or BP cuff would have caused this type of damage as those usually cause vein damage not catheter damage. Overpressurization from forceful flushing against resistance or using a very small syringe (e.g. 3 mL) could cause a slit downt he length of the catheter and this would not be around the circumference. Since this has bee happeing for a long time, it sounds like there are more than 1 lot number of PICCs involved, but you should find that information if possible. You should also contact the company directly and discuss this issue. They have ways to retrieve an explanted catheter, and have their engineers closely examine it. You should also document this using the volunteer system on MedWatch and also report these to your Risk Manager or whomever writes the semi-annual reports about device/product problems. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
It could be caused by the guidewire being moved in the catheter prior to flushing with saline. (Bard's literature states not to do it.) the wire might cut into the cath causing a weak area. I would think this would fall in the area where the looping of the cath happens when setting up the catheter for insertion. Just a thought.
thanks we always flush before removing the guidewire so good thought but i don't think it's this
We are confused. If the split occurred below insertion site? Wouldn't it still be in the vein? How did the extravasation occur.
The break could easily have been inside the vein yet close enough to allow infusing fluid to leak from the break into the SC tissue. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861