Has anyone every experience a guidewire getting stuck in the arm? I had excellent blood return, was able to advance the wire about 4cm past insertion site and then hit an obstruction. I changed the angle of the needle and gently tried to advance the wire without success. I then pulled back the wire and needle as a unit. The needle came out but the wire would not move. I tried warm compresses and nitro paste in the arm hoping it was just a spasm. After about one hour we called on the vascular surgeons, it was suggested to insert the introducer and remove the wire, but that didn't work either. No one was willing to come back in to remove the wire, both suggested a sterile dressing and they would remove it in the a.m. The following morning the patient was taken to IR and the wire was easily removed through an introducer without difficulty.
Yes Yes and Yes
Three times in the past 12 years we have experienced a traumatic stuck catheter incident that required IR remediation
The most recent time was just last week--The Radiologist had to do a cut down to remove the tip of the introducer wire that became knotted as it was being removed
The first time--We were unable to position the patient's extremity in an optimal position for PICC placement and the wire was accidently driven through the vein and was subsequestly removed at the bedside by the radiology tech who actually unraveled the wire to remove it from the patient--We never attempted another PICC placement on this patient
In the second incident a small piece of the wire broke off in the patient arm but IR opted to leave it in situ and this patient has since had several PICC placements
Robbin George RN VA-BC
I would bet a huge amount of money that you are dealing with venospasm. This has been reported with PICC removal. The answer as to why it takes so long to remove is found in normal anatomy and physiology. The middle layer of the vein is made of smooth muscle. This layer can go into strong contraction with very little stimulus. It can also hold that contraction for extended periods of time with very little energy expenditure. One of the articles on stuck PICCs from about 20 years ago recommended a tincture of time as all that was needed. I would say that any cutdown is premature unless you have allowed up to 24 hours first. There are drugs that can relax smooth muscle but the usual muscle relaxer meds only work on skeletal muscle. 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
I had one friday that even though I had excellent blood return I could not get the guidewire to advance no matter what I tried. I wonder if it was the same thing? The pt was shall I say a very excitable person.
It could have been venospasm as I have seen it on insertion and removal. 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