We have a pt with a picc who c/o feeling like he is going to "pass out" when we flush with saline. We have verified placement and can't find any other reason this would be occuring. He does have a strong cardiac hx. I'm wondering if anyone has ideas. Thank you.
Jennifer Estela-Stollwerck, RN, BSN, CRNI
My first thoughts are how fast are you flushing the saline. Are you using a turbulent or stop-start technique? Rapid, forceful, turbulent flushing methods could be doing a couple of things. 1. It is quite possible that it is causing the catheter to radically change tip locations. Infusion induced catheter movement with flushing techniques has been demonstrated in animal labs and bench testing, although this work is just now getting into our discussions. We have a new online CE course that discusses this - Perils of Power Injection at www.hadawayassociates.com.
2. If the tip location is not changing, it could still be located close to baroreceptors in the SVC and flushing is causing changes in the pressures detected by these baroreceptors.
Fainting is usually associated with a decreased blood supply to the brain.
Read more about feeling faint at this location:
http://www.healthblurbs.com/causes-of-faint-fainting-pass-out-passing-ou...
I would try flushing with a slow steady gentle flow and see if anything changes with the patients reaction.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Fainting can be caused by a vagal reaction which causes a sudden drop in heart rate. Have you monitored the patients pulse while flushing? The cardiac history you cite makes this a real possibility. Vagal stimulation can be caused by physical and psychological triggers.
Rick Simpson RN, CCRN
Richard Simpson RN, CCRN