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Unexplained PICC bleeding

I placed a PICC on a patient to RUA without problems. Using Arrow PICC kit, accessed the vein just fine, very easy thread all the way to a bullseye using Vasonova, when I removed the dilator, I could not stop this line from bleeding at the site. I held pressure for at least 20 min, finally had it somewhat under control. I placed a biopatch and packed with gauze internal and external. I removed an ultrasound IV  about 3 - 4 inches below my PICC, and I had trouble getting this to stop bleeding also. I ended up placing a stat seal disc at IV site to stop the flow. Everything seemed under control. I left the room, about an hour later my co worker ended up removing my line because she was called to the patient's room due to abnormal bleeding, the PICC site was literally pouring a trickle of blood that could not be stopped. I have never had this happen in my 15 years of placing PICC lines. I'm baffled.  Some patient information I have is labs of platelets 218, no PT/ INR noted, but patient was on lovenox which I have never seen happen on this med before, also COVID 19 +. Could someone please provide me any feedback. We take pictures of all of our accesses and I checked mine and I was clearly in the vein with a proper bullseye CA-JX placement 

Could your introducer have

Could your introducer have gone through a very small artery or arteriole with PICC insertion? Even with Lovenox blood should clot at some point. I am assuming the PIVC site clotted with the statseal. Did you use statseal on PICC site? That may have stopped it if the problem was clotting factors from the Lovenox. Otherwise a small artery could have been damaged. Speculation of course. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Just small steady stream of

Just small steady stream of dark blood from picc site itself, but started about an hour after original insertion. I didnt have any trouble with bleeding until dilator was removed and after 20 min of pressure, I was able to stop the flow. Did not put stat seal disc on because I had it controlled and just packed with pressure dressing. Bleeding started about an hour later. We had no choice but to remove PICC because the steady flow would not stop! We checked on her the next day and her arm looked perfect, no problems or bruising. Just don't understand what went wrong. MD  says her liver enzymes were a mess and her body temp was 95, so they think she just could not clot well with a cold body, but lab work was good next day, H&H was better than when I placed on day of after all that bleeding. They still did not do coags, so not sure what those may have been! 

Gina Ward
Oh I would have had a fit

Oh I would have had a fit that the nurse removed the line...    Why didnt they call you??  then you could have attempted to place Stat seal on it.   Most likely in that situation the stat seal powder would be better than the disc.

I have had that happen before as well and even had to replace the Statseal a time or two in my shift  but then it eventually resolved.   There was one patient where we did actually eventually remove the Midline and then it clotted off and sealed up just fine.   We felt like the Midline was just continually traumatizing the skin nick and once that was removed it allowed it to seal up and stop bleeding.

Sometimes your dermatotomy may get a little too big and  see a bit more bleeding than you expect.  But.....these pts with the Covid really have issues with bleeding and clotting, and then as you mention liver issues on top of it could contribute.


Gina Ward R.N., VA-BC

I agree with the previous

I agree with the previous thoughts like small artery transfixed because I even saw one open heart surgery pt  coded with the same issue. On another consideration, COVID is an endothelial disease. I recently saw one covid patient had abnormal consistent bleeding from previous iv site , he had hemiptosis  as well.  The pt was really not doing well. Or ( I believe you checked on all possibilities) if pt has hx of CAD or s/p stent or A fib..... aspirin or factor Xa inhibitor doesn't change coag levels, but still pt can bleed so much to death... I had one pt stopped eliquis 4 days ago before midline insertion and bled for hours....and so on.

Kate Shin

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