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Steve1
Ruptured PICC within vein

Hello

Grateful for your thoughts. 4F pressure injectable polyurethane PICC same make placed in three different patients. Different Lot numbers developed small horizontal split. My concern is that these splits occured within the vein.

1. 400+  dwell days: Removed as occuded. 2 mm split at 20cm point (around axilla). Company attributed to fatigue from repetitive joint movement.

2. 150+ dwell days. Patient with history of frequent status epilepticus. Following fall user noticed leak on flushing. Removed: 2mm split at 12 cm point. Never used for CT contrast.

3. 50+ dwell days. patient walking with crutches. PICC blocked  and removed. 2mm split found at 8 cm point (PICC placed high up on arm to avoid pressure from the crutch). Never used for CT contrast

All PICCs secured by a subcutaneous device. We have decided to go back to a silicone PICC for our community patients. I have noticed the PICCs of a few manafactures kink easily and with repitition a pale fatigue line develops (a bit like the collapse and marking in an acutely bent and flexed cardboard tube). No harm resulted in these cases and with hindsight the second two patients will have placed focal repetitive movement on the limb. Has anyone had similar experiences?

Thanks

Steve RN

 

lynncrni
Not sure what  you mean by

Not sure what  you mean by horizontal split. If you mean a linear slit along the length of the catheter, the most common cause of this is overpressurization by applying far too much pressure to the plunger rod of a syringe against resistance. Even a 10 or 12 mL syringe can cause this damage if enough force is applied and resistance is felt. Since these were all power injectable in for lengthy period, the material fatigue adds to the problem. I would speculate that the weakened spot from use is what gave way when the high pressure was applied. Going to a silicone catheter will not prevent this as silicone can be slit also. Polyurethane has greater mechancial strength than silicone. Silicone derives its mechanical strength from the thickness of the catheter walls, so you sacrifice lumen size or outer diameter. Focus on staff education. When injecting any fluid for any purpose from any size syringe, ALWAYS stop if resistance is met. ALWAYS assess patency with a 10 mL syringe as this size allows the lowest amount of intraluminal pressure but this is not the complete safe harbor that people like to think. You can still apply enough force with a 10 mL syringe to cause damage. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

PICC fracture,

Have you considered changing the product that you are using???

Terry

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