bleeding from PICC
Twice within the last 2 months I have something happen that has never happened before. In the first case I placed a PICC in the brachial vein. The vein was to the side of the artery and a clear stick into it. Abotu time I got the drapes and needles cleaned up the site started bleeding and we could not stop it by holding pressure, pressure dressings, or surgicel. the line was removed due to bleeding. The chest xray showed the line in the SVC and the INR and PT and platelets were all normal. The patient did have a lot of tight edema in upper arm but it would still pit. This was the only vein in her arms that was large enough to access. Did not have other choices.
The second case was a brachial vein sitting on top of an artery. Again a clear stick with tip in SVC per xray. Line started bleeding and we were able to control bleeding with D-Stat but patient would start moving around and make it start to bleed again for 2 days. The D-Stat had to be reapplied several times. The brachial was the only vein available in this patient also. The patient also has edema in her arms with normal PT, INR, and platelets.
I don't know what happened and don't want it to happen again. Anyone have any suggestions other than avoid brachial which do whenever possible?