PICC for Sunday, September 29th, 2024

Contributed by Cincinnati Childrens Hospital Medical Center
Jamie Webb RN, Barb Rhymer RN, and Neil Johnson .

History

Patient with bilateral upper limb PICCs. RIGHT PICC is no longer functioning. Bedside Nursing staff unable to flush or aspirate, therefore Vascular Access Team unable to infuse tPA (Tissue Plasminogen Activator).

Clinical medical staff requested Interventional Radiology (IR) procedure for guide wire assisted PICC exchange, assuming that the lumen had become occluded by thrombus. IR attending declined to exchange PICC and suggested an alternative "procedure".

Images (Click any image to enlarge)

Question

What is the real cause of the Right PICC malfunction?

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Correct answer

The PICC Is kinked near insertion site and therefore completely obstructed near the insertion site at the right elbow

Discussion

The PICC is kinked near the insertion site in the right cubital fossa, probably due to inadequate or dislodged dressing. This was initially not reported on the routine radiology report and was only identified by IR during a consultation requested by the Vascular Access Team.

Solution was to replace the dressing and resolve the kink! We have seen other cases where bedside medical staff pressure flushed the catheter and ruptured the PICC!