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» LymeNet Flash » Questions and Discussion » Medical Questions » PICC won't give blood

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Author Topic: PICC won't give blood
SickSam
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So sometime writhin the past 4 days my PICC decided it doesn't wanna give any blood. It flushes completely fine, but we can't get any blood return on it.

Anyone ever have this problem? Wondering if I need to be concerned.

I had a chest X-ray last week and it was in the right spot, but I guess it could've moved since then. It was giving blood at that point in time too.

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me
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That happened to me several times when I had a PICC line. The nurse said as long as they could flush it, it was fine.

However, I would definitely check with your nurse or doctor and get their opinion.

Best.

--------------------
Just sharing my experiences, opinions, and what I've read and learned. Not medical advice.

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SickSam
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Thanks me, good to hear. My nurse said it happens to people sometimes and it's fine, but I always like to get a second opinion. (:
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Notti
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What 'me' says is correct.

Sometimes it helps to lift your arm over your head, or you can try lying on your side while trying to draw blood from the PICC line. Coughing can help as well.

Anyway, as long as you can flush it, it's fine!

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sammy
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NO!!!!!!

It's not fine!

This is assuming you've tried repositioning your arm above your head, turning your face away from your raised arm, coughing, and such to reposition to see if you can restore blood flow that way.

You should only use a PICC line, midline, or Port if you can get good BRISK blood return and flush EASILY.

If you cannot get good blood return but you can flush easily, you most likely have a fibrin sheath building up around the outside of the PICC.

Something dangerous is that many antibiotics can be caustic, when you have a fibrin sheath the antibiotic back tracks along the catheter then out into the vascular system where the veins are smaller and have less blood flow. This causes vessel damage. Normally with PICCs, the catheter enters directly into the central circulation, right above the heart.

A dose or 2 of Cathflo will usually clear this problem of fibrin sheath easily. Your nurse will do this for you.

Do not try to force flushes if you have resistance, you can cause the catheter to rupture, creating an embolism, with high risk of leading to a stroke.

If you have no blood return and do not address it, the problem will only get worse. It could be also be a sign of malposition, where the tip is digging into the vein wall. This can cause damage or even a tear or whole in the blood vessel.

If you have no blood return due to fibrin sheath, it can eventually close off the tip with a clot so that you cannot flush either. Then it is very hard to salvage the PICC. Much Cathflo will be needed and it may not work.

I could go on but you get the idea. Don't ignore the malfunctioning PICC. It can have serious consequences friends.

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dbpei
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Wow. Thanks for this info Sammy. Last year I had a picc and started to have a problem with blood return the last week or two. It turned out that I did have a fibrin sheath, which we discovered after it was pulled.
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bluelyme
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Is the same for ports too?

--------------------
Blue

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SickSam
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That's what I was afraid of Sammy. ): That is pretty much what I've read about lines that won't return blood.

It's flushing with zero resistance right now, which is good. I flush pretty hard and fast too, and it flows fine right now.

I've tried different positions, etc, but nothing has worked. I see my doc in two days. I'll be sure to tell him and see what he wants to do about it.

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Notti
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As with everything in nursing, opinions differ obviously.

I still think what 'me' said is correct. There is no reason to panic, but it is best to contact your doctor or nurse.


https://www.nursingtimes.net/roles/nurse-educators/managing-occlusion-in-central-venous-catheters/200818.article

"If there is free-flow but no blood return: Free-flow but no blood return is a relatively common occurrence: some CVCs fail to allow blood return due to the catheter tip being positioned against a vessel wall.

But in a situation where flashback fails in a catheter that previously bled back well, an attempt to restore full patency is desirable both to allow blood sampling and to reduce the chances of allowing fibrin and platelets to build up.

In the meantime, the catheter is probably safe to use, although when giving irritant drugs or fluids, it is reassuring to test the safety of a CVC which does not bleed in adults by rapid administration of 250ml 0.9% saline over 15 minutes.

This technique is used successfully in our oncology unit and was agreed by the multidisciplinary team rather than being based on any particular evidence or research.

If the patient experiences any discomfort at all related to the infusion, or if there are any other unexplained and abnormal phenomena during the infusion, then it should be stopped immediately and medical advice sought.


An angiogram should be carried out, and the line should not be used for irritant drugs or fluids or chemotherapy until it can be shown to be correctly placed and free of complications.

If the patient experiences no discomfort related to the infusion and there are no other complications, then the nurse may proceed with treatment."

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sammy
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Right, there is no need to panic. Instead, you should discuss this issue with your nurse and they can contact your doctor for Cathflo orders.

It is important for your nurse to know and understand this because here in America, all nurses are held to the highest standards.

If any of adverse events were to occur when the nurse did not check for patency of the CVC (PICC, midline, port, Hickman,...), the nurse could be held liable.

In a court of law, the "Infusion Nurse Society Guidelines 2016" are the gold standard to which any healthcare professional would be held accountable under.

These guidelines are very specific in stating that you must have brisk blood return and free flowing easy flush for a CVC (PICC, port, midline...) to be considered patent.

Some nurses simply do not have the specific IV therapy experience and knowledge to know the risks of using a CVC without blood return (some of which was explained above in last post...).That is where the confusion comes from.

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SickSam
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Thank you Notti and Sammy. I really appreciate the insight and input!

I did see my doctor today and he said it probably has build-up on the end of it. He wasn't concerned about it at all. I guess I'll keep using it and if I start getting unusually weird symptoms or if it starts getting hard to flush I'll ask him again.

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Notti
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That's good to hear Sam.
And, as you say, it's always good to pay attention to new symptoms.

I don't know if your line is locked/closed with heparin? According to the latest research heparin isn't needed and filling the line with saline only is enough, but in practice heparin often works better.

If your line is locked with saline only, you could ask your doctor or nurse if heparin is an option in your case, if the problem gets worse.
Do pay attention to the combination with your other medications, to prevent interactions and adverse reactions.

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SickSam
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I do use heparin, even though supposedly to isn't required with my type of PICC.

It does seem like it might be getting harder to flush as of yesterday. I might just rub paranoid though. It could just be kinks in my extension possibly too. I'll put a new extension on soon and see if it helps.

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Notti
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Keep us posted!
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