Managing Common PICC Related Complications
Even though PICC related complications are low, PICC practitioners and those who care for PICC lines must know how to manage them.
In most instances, redness and swelling around the catheter site is due to mechanical or chemical irritation and is rapidly reversed. But the site should be monitored for possible infection. An aseptic technique during insertion and care, avoiding catheters placement in areas of flexion, and simple symptomatic treatment with analgesics and compresses is usually adequate. However, if it persists and does not resolve, another line may need to be cannulated at a different site.
Occlusions in the catheter can occur from drug precipitation, fibrin formation or thrombosis. Often it may be difficult to determine the cause. Proper care with flushing regimes and techniques can greatly increase catheter functionality. However, even with the most religiously cared for PICC line, instillation of a fibrinolytic agents may be necessary and successfully treats any occlusion problem.
The fight starts with meticulous attention to cleanliness and aseptic technique during all phases of PICC care. Once the PICC line is successfully and sterilely inserted, the goal is to continuously monitor for the presence of infection as well as performing regimens with attention to maintaining sterile technique when required. If an infection is detected, the aim is to quickly localize the infection, use of antibiotics, and removal of the PICC line if necessary while closely monitoring for any progression.
Catheter Fracture or Embolism:
This is sometimes noted when the catheter leaks or when holes or breaks can be visualized. However, occasionally only the tip breaks off and migrates. This can cause symptoms like cyanosis, tachycardia and a change in consciousness.
Air Embolism Emergencies:
Air embolism can cause serious emergencies, as large amounts of air can enter and lodge in the circulation, brain or heart chambers. Although rare, a close vigil must be kept, and any signs of chest or back pain, shortness of breath, hypotension, tachycardia and a change in consciousness should require prompt action.
It is important not to forcefully attempt to remove a PICC line. If the line is difficult to remove, after allowing the patient a considerable length of time to apply warm compresses to dilate the vein, for the venospasm to resolve and the patient to relax should it be reattempted. Venospasm is often the cause which usually resolves with time and warm compresses. Forceful removal can result in vein or catheter rupture.
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