Placed a 4fr Groshong PICC yesterday on 32 yr old paraplegic for staph abcess to buttock. PICC placement went well. 1 stick with microintroducer and ultrasound guidance to left basilic vein. Used 1ml 1% lidocaine during procedure. Aspirated for blood prior to using lidocaine, no blood return.  Used sherlock for aid in tip location. No complaints from pt during procedure. Immediatley following placement, approx 3-5 minute dwell  time for PICC, pt started with allergic reaction. Pts became itchy, cheeks started to swell, thrroat started to swell and she had that impending sense of doom, pt became very anxious and c/o SOB.  Pt had PIV in place infusing vancomycin at the time of the PICC placment.  No problem with PIV during procedure of after PICC placement.  Any ideas on what happened?  PICC line was removed, MD contacted and benadryl and decadron given IV.  Pt doing fine.  Just not sure how to explain?  Could the lidocaine can cause this reaction?  Pt has one allergy to PCN.  After talking with pt, pt has had lidocaine on numerous occasions.  Could it be the PICC line?  Any thoughts would be helpful.       

More than likely this was

More than likely this was mast cell activation syndrome, also known as idiiopathic anapylactic reaction or an anaphlytoid reaction. This is not an allergy however the patient should be referred to an allergy specialist to rule out allergy and get a proper diagnosis. This results from a mechanical stiumulation of mast cells. The vancomycin was also chemically stimulating the mast cells. Allergies are stimulation of the mast cell by an immune globulin, IgE. In these cases, do not remove the PICC or midline as this may be your only IV access for medications. Epinephrine is the first line of treatment. You can find more on this forum by searching for mast cells. 

 

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

www.hadawayassociates.com

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

Hi, Amy: Search "mast cell"

Hi, Amy:

Search "mast cell" on this site. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RN VA-BC
Nurse Educator IV Therapy/Vascular Access Fletcher Allen Health Care