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» LymeNet Flash » Questions and Discussion » Medical Questions » PICC line sluggish, suggestions?

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Author Topic: PICC line sluggish, suggestions?
sammy
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I have a double lumen PICC line and noticed last night that one of the lines is running more slowly than the other.

I tried to flush the line and it seemed like I needed more force than usual. So then I tried to aspirate some blood from it and I was able to do that slowly, so then I proceeded to flush with saline and started the antibiotic.

I was able to flush the line again and used it this morning but it still seemed to run more slowly than the other line. It concerns me but I'm not sure what I can do to make it run more freely again. The other line flushes/runs easily.

Anyone ever have this problem? Did your doctor prescribe a clot buster like "Cathflo"? Or do they only do that if there is a complete occlusion of the line?

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SarBear
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Sammy,
This same thing has happened to me on and off. Most of the time they will just leave it if you can still flush from it and draw from it. However, twice now my line has been so occluded that they can not draw from it. Then they do the cath-flo. I guess that since they are such small lines, sometimes they get kinked, or they can grow a fibron sheath at the end of them. I was told that it really was nothing to worry about as long as it is flushing and drawing. Good luck!

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sammy
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Thanks SarBear. I was concerned so I went ahead and called my doctor this morning. Didn't want to get to the point where my line clotted completely or broke, I don't want to have a new one placed.

Of course my doctor recommended going to the ER since he is out of state. That didn't sound good to me. So I called and talked with a PICC nurse at the hospital. I am going to go in tomorrow to have one of them look at the line, test it, and administer Cathflo if necessary.

I don't think that the ER would take the time to try to fix it. Thankfully my doctor was willing to write orders based on the PICC nurse's recommendations. Hopefully this will be a simple fix.

If anyone reads this post, please keep me in your prayers. I really need this line to last just a few more weeks or months to finish IV therapy. I want so badly to be well again.

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springshowers
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Sammy

WHen I had my picc line that was also a double .. it just stopped being able to run at all and I even was at the clinic and they kept trying to push and push and it was stuck..

They were about to call the doc to get an order to put in the clot buster .. but
then... I just moved it around and tried it and it worked.. IT was kinked somewhere and just changing the positioning of the line worked.

So they undid the whole taping and repositined it all and it worked again

THis happend a couple times actually and I learned to watch for it or try different positions or moving the tubing around a bit.

You can not even see that it is kinked.. it all looked just fine.. but upon trying to change it around it was like night and day?

Who knows?

But.. AN idea to keep in mind..

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sammy
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Thanks spring. I was due to change the dressing and caps today so I went ahead and tried to flush the sluggish line again. It actually worked a little better this evening so I ended up infusing my antibiotic too.

I hate having to deal with these kinds of situations. It is still working so part of me just wants to watch and wait for now. But I'm also scared that if I wait it might get worse.

I guess it is best to be safe and have it checked tomorrow. I still had to use more force to get the flush in so I know that that is not right.

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springshowers
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WEll Good Luck to you..

I know how it feels.. and can be frustrating..

I was amazed how easily it was fixed for me in the end so I just wanted to pass that along....

Its good your getting it to work somewhat. If you can flush it more often for awhile maybe that will help... I started to flush it 4 times a day for a few days and that got it working once too..

These things can be finicky .. but also better safe than sorry on them too

I got sepsis from my port so I know its nothing to mess with..

Sounds like you your doing all the right things.

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sammy
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Thanks again.

I went to the hospital today and the nurse had no problem flushing the line. I wouldn't have believed it if I hadn't seen it. Our prayers were answered because my PICC line seems to be working fine now.

The nurse acted like I was crazy when I got there. She didn't understand my doctor's order to check the line and administer Cathflo if needed. What's not to understand about that? Anyways it flushed easily with saline, didn't need the Cathflo, and i'm infusing my antibiotic now.

I'm just so glad that nothing's wrong with it. I so did not want to have to get another line placed. Hopefully I'll start to feel better soon so that I can stop the IV's all together.

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Rumigirl
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Well, just watch it carefully. The fact that it was sluggish shows that something was up. I had that on and off for a while, except

that mine leaked on and off, too! (Not good!) The Cath-Flo stuff helped briefly, but then it leaked like crazy, and the line had to be pulled.

That's not your situation, but it's not right when it doesn't flow easily and properly, so keep an eye out. And don't let anyone make you feel funny for getting it checked. It's your life.

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lou
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So, rumigirl, how did you know it was leaking? Unless it was in the part outside the body?

My PICC is also working hardly at all. Some of it has come out more than it did when inserted. How much can come out before it leaves the vein? How far into the vein does it go?

No local support. Don't know what to do. Doctor too far away to help.

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sammy
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Lou, sorry to hear that your PICC is not working well. Is it difficult to flush? Do you have one lumen or two, are both slow?

Do you think that the line might be kinked, bent, or malpositioned? Try repositioning your arm. The end of the line might be resting against the side of the blood vessel causing it to flow slower.

If you notice resistance when you try to flush or infuse, stop. Do not try to push it. You can push a clot (causing pulmonary embolism) or break the catheter.

Have your doctor write an order for the local hospital's PICC team to evaluate your line and treat with Cathflo if necessary. If the line is clogging (with a clot or fibrin sheath), Cathflo will clear it out and restore function.

Also, your line can migrate out by a couple centimeters. Don't try to push it back in (germs can enter into your blood stream causing sepsis). If your line comes out more than a few, 3-5 cm, notify your doctor. He/she may want to order a chest xray to confirm placement.

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Rumigirl
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lou,

sammy is absolutely right. You need to get it checked ASAP. The line is supposed to be stitched in place, when the place it, so that it doesn't migrate out, as it sounds like yours may have.

If not stitched, then an infusion nurse can put on a device (I forget the name) that keeps it in place---Cath-lock, I think it's called. Infuserve carries them, as probably would medical supply stores.

With mine, yes, it was leaking in the part that was external, so I had to have it removed. : - (

As sammy said, don't try to infuse, if it's not infusing properly. Get it checked---too dangerous otherwise. Go to your nearest hospital, since you don't have an infusion nurse. But ask for infusion care nurses, as nurses who don't have experience with this may not know the proper care. Cancer infusion centers would know, as they do this for chemo.

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lou
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I have no medical support and don't think my previous doc, who is now out of state, will be much use, or have his orders accepted by any hospital here. Don't think there are any lyme docs in my new state.

Seems like my only choice is to go to the ER, where they may not know what to do with PICC malfunctions. But that is the only place a patient can go without a referral/order. So, I will ask if they will do an ultrasound/chest xray. Would they do cathflow, or would only infusion nurses know about this?

Have changed the extension, tried repositioning the external tube, changed my arm position. Nothing works. Now trying enzymes. Could lifting boxes have done this? I moved recently and it is hard to avoid lifting boxes.

I hate our medical system.

P.S. It is a single lumen. And since I am changing the dressing myself, statlock not being used. Too difficult to do this one-handed.

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maps
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Wow you guys I can't believe that you need to do all this yourselves you are amazing, I would be terrified.

I know my nurse infuses heperan every two or three days maybe this would help you.

regards
maps

--------------------
1999 CFS, 2002 CMV Myco pneumonia
1 year antibiotics on and off
2002 EBV, 2009 Positive Igenex Borellia and Babesia, Brain mri severe white matter disease
Monoclonal Gammopathy. On and off antibiotics since sept. March 9 started iv antibiotics

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keltyl
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Lou....I've been to ER, at least they can give you a chest xray to make sure the line is in place.Do you have someone help you change the bandage or do you do it completetly by yourself? If you do...wow!

This is my 2nd picc, the first was much different than the 2nd. I pulled the 1st one out by not being careful. This is a double lumen, and much sturdier. I don't use a statlock either. In fact it has taken 8 mos to find something non-irritating to my skin. Clean with betadaine swabs, wipe with saline, a bio-patch, 4x4 sterile gauze with paper tape, and wrapped with coban (nothing can move). I was allergic to everything!

Sammy...I now have a double lumen and this one has always taken 1 1/2 to 2 hrs to run. One they couln't get blood from and is a little harder to flush, the other they were taking blood from but a couple weeks ago it was drawing very slowly. The nurse said it sometimes has to do with how it is laying in your arm, or something like that. I now have them draw from my other arm w/o using my picc. I need my picc to last hopefully another 4 mos. Been thinking of you , but not on the ball.

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Tracy9
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When my PICC line was occluded it had to be pulled; it was due to blood clots. I was told never, ever to force it or to play with it.

I don't get the Cathflow, isn't there a risk it could push a clot into your heart? That sounds very bad to me.

I lost two PICC lines and a heplock due to clots and can never get a line again. I was told this was life threatening, and to never, ever, ever try to force anything through a line.

--------------------
NO PM; CONTACT: TracyWill9@yahoo.com

13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG.

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keltyl
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Also, those of you with picc lines, my doc told me to take a baby aspirin a day. Anyone else?
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Rumigirl
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lou,

You're changing your dressing on a PICC line yourself?? You've only got one hand to do it with!! Isn't there anyone who could learn to do it and help you?

But first you need to get it checked, and make sure it's ok.

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lou
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Went to ER, got cathflo, works better now but not optimal. Was told that platelets and precipitate from meds can build up to cause low flow. Very small diameter tube. Not meant to last a long time. Got no xrays, ultrasound. Was told that lifting boxes probably had nothing to do with it.

The real problem is that low doses of IV are the only thing that helps much, slows down the wasting. When I stop meds, arthritis comes back and other problems accelerate. If only I was one of those people who can take a doxy now and then and stay functional! But needing an IV device implanted forever just does not seem like a good future, even if I can get anyone to do it.

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keltyl
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Lou...You are right, picc lines can't be in forever. Rocephin is the only thing that has given me any improvement at all too. I talked to my doc last visit, and told him I'd like to go for a year (which will be the end of Aug). I think as long as everyting goes ok, he'll go for it.

I'm so afraid once I stop, I'll go back down. I did over a year of orals and bicillin shots, nothing helped at all.

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