I have a pt. that has a single lumen PICC line in his left basilic vein. Upon measurement, the catheter should have only occupied 17% of his vein. The pt. had the PICC in for approximately 16 days and then started complaining of feeling a "shock"(he describes it like getting shocked by an electric fence) to his nipple area only (both right and left) during movement. He states that this doesn't occur when resting. A repeat CXR showed the tip at the caval junction. He denies that the "shock" travels down his arm. He denied any tingling and there was no swelling to the left arm, therefore we didn't do an ultrasound of the arm.
Has anyone had an experience like this?
This sounds like paresthesia
a sensation of pricking, tingling, or creeping on the skin having no objective cause and usually associated with injury or irritation of a sensory nerve or nerve root
Movement of the catheter tip when the patient is moving is impinging on some nerve. Numbness, tingling, "pins and needles" feelings or shocklike feelings are all paresthesias that can easily be related to catheter insertion and/or movement. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn for your quick response. Would you suggest that we remove the line and replace on opposite side? He will need 4 more weeks of antibiotics. Would you suggest an ultrasound?
Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA
Where was the catheter tip located on insertion? If in a suboptimal position, it may need to be changed. If the tip is moving it could also be related to a subopitmal tip location high in the SVC. Has the catheter become dislodged from the insertion site either into or out of the vein? What patient movements produce this sensation? What does he feel during injection or infusion? All of these factors would need to be considered to determine your course of action, so I can not make any recommendations. I have serious doubts that an ultrasound would provide any useful information about this one. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The insertion vein was the basilic vein. A repeat chest x-ray done at the time he was reporting these symptoms. The catheter tip is at the caval junction. He doesn't complain of any "shocks" during medication administration or at rest. He complains of this "shock" feeling while showering at home. He first noticed when he was here in the hospital and would get up from the bed to go to the bathroom.
Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA
What is his arm position when he feels this? I still think there is some nerve involvement somehow. Very strange situation. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861